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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000958
Report Date: 10/11/2019
Date Signed: 10/11/2019 01:19:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FAMILY SCHOOL CDC BERNAL GATEWAY, THEFACILITY NUMBER:
384000958
ADMINISTRATOR:HAYNES, MARILYNFACILITY TYPE:
830
ADDRESS:3101 MISSION STREETTELEPHONE:
(415) 550-4178
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:16CENSUS: 15DATE:
10/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Amalia JustoTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Wendi Wittmeyer and Farhan Bashir-Tariq met with Lead Teacher Amalia Justo for an Annual Inspection. The purpose of this visit was explained. Present today are 15 children with 3 staff . Facility meets teacher/child ratio. An inspection of this facility was done. This program is located on the first level of the building. Hours of operation: Monday to Friday 7 30 AM- 530 PM.. There is one classroom with a kitchen, Bathrooms are clean and have adequate supplies. Classroom is well lit and have adequate ventilation. There are age appropriate toys, arts & crafts supplies and learning materials in the classrooms. Furniture and equipment are age appropriate and in good repair. Facility serves AM and PM snacks and an outside food vendor Chefables provides lunch and breakfast. First aid supplies are available in each classroom and were inspected. Medication storage, is located in classroom near the child needing it.. When a child becomes sick they are isolated in a small sitting area in the classroom until parents can pick them up The classroom has a carbon monoxide detector and smoke alarm. There are cots for napping. Each child has his/her sleeping bag and parents launder them weekly. The play yard is located directly behind the classroom. There is a play structure with slides, a large sand area, and outdoor toys. A soft cushioning material surrounds the play structure. This facility uses sign in/out sheets by the front door, All required documents are posted including the current snack/lunch schedule.
LPAs reviewed a sample of staff files. Multiple staff have current First Aid/ CPR certificates. LPAs did not observe mandatory training certificates in staff's files present today. LPAs observed immunization records for the staff present today.
LPAs reviewed facility records and 8 random Children's files and they were complete.
Last fire/disaster drill was conducted on 8/29/19 .
LPA discussed the effects of lead exposure with the staff and a handout was provided.
Amalia Justo was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Influenza Declarations were also reviewed.
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SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Wendi WittmeyerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FAMILY SCHOOL CDC BERNAL GATEWAY, THE
FACILITY NUMBER: 384000958
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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H&S Code 1596.8662(3)...On and after January 1, 2018, a person who becomes an administrator or employee of a ll complete the mandated reporter training provided pursuant to paragraphs... mandated by AB 12..

This requirement is not met by evidenced by :
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Based on observation and records reviewed today, facility staff present today do not have evidence of training.

This poses a potential Health and Safety risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Wendi WittmeyerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FAMILY SCHOOL CDC BERNAL GATEWAY, THE
FACILITY NUMBER: 384000958
VISIT DATE: 10/11/2019
NARRATIVE
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. Amalia Justo was advised of Pesticides training. For More information about changes to the Healthy Schools Act, templates, articles, and required training you can inspect the DPR website at: https://apps.cdpr.ca.gov/schoolipm/childcare/training

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPAs reminded the staff that As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com

Facility was informed about the Provider Information Notices (PINs) on CCLD website.


Type B Deficiency was cited today: See LIC809D. The copy of this report is reviewed and provided to the Amalia. Notice of site visit must be posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Wendi WittmeyerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3