384000958-2-8-2024-05-CC-LGOZ-D29TCC-20240208133630

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000958
Report Date: 02/08/2024
Date Signed: 02/08/2024 01:37:39 PM

Document Has Been Signed on 02/08/2024 01:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	FAMILY SCHOOL CDC BERNAL GATEWAY, THE		FACILITY NUMBER:	384000958
ADMINISTRATOR:	HAYNES, MARILYN		FACILITY TYPE:	830
ADDRESS:	3101 MISSION STREET		TELEPHONE:	(415) 550-4178
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 16	TOTAL ENROLLED CHILDREN: 16	CENSUS: 14	DATE:	02/08/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Gloria Lopez, Patricia Bacerra		TIME COMPLETED:	01:45 PM

NARRATIVE

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On 2/8/2024 at 8:30AM., Licensing Program Analyst, (LPA) Luis Gomez met with Teacher, Gloria Lopez. Purpose of the inspection was explained and is for an Unannounced, Random inspection. The combination center operates an infant/ toddler program with a preschool program onsite. Present was the lead teacher and 6 staff supervising 14 children. Present staff have criminal record clearances of file. The children had been properly signed in. Director, Patricia Bacerra arrived during the inspection. The infant/ toddler program utilizes two rooms: infant classroom, (0- 23 months), Toddler classroom, (18 – 36 months) and one, shared, outdoor play yard. Day and hours of operation are Monday- Friday, 7:30AM- 5:30PM. Program operates year-round. LPA inspected facility for health and safety hazards.

At 8:40AM., LPA observed the following: Infant/ toddler classrooms were clean, orderly, with age-appropriate playthings available for the children. The floors/ ground surfaces were free of obstructions or possible hazards. Accessible furniture, toys, and playthings inspected were in proper repair. The classrooms were equipped with cubbies for storage belongings. Facility’s diaper changing tables had been placed within arm’s reach of a sink. Per director, diaper changing mats are disinfected after each use. Infant feeding chairs were equipped with wide- based legs, with a detachable table component. The toddler classroom had child- size tables and chairs available for seated activities.

For napping services, LPA observed cribs located separately from the play area. The infant cribs have visibility on all sides to ensure constant staff supervision. The cribs inspected were equipped with properly sized mattress and tight-fitting sheet. LPA observed several stackable cots made from a cleanable material. Per director, napping sheets and linens are washed weekly by families. The facility was a comfortable temperature with ventilation and lighting. Trash bins had been properly covered. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/08/2024 01:37 PM - It Cannot Be Edited

Created By: Luis Gomez On 02/08/2024 at 11:29 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 02/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 11:30AM., Based on record review and interview, LPA confirmed facility has not conducted required emergency drill within the last 6 months. This poses a potential health and safety risk to children in care.
	POC Due Date: 02/12/2024
	Plan of Correction
1 2 3 4	Director will conducted emergency disaster drill with infant program by due date (2/12/2024). Director will submit proof of correction, updated disaster log, to the department by email.

Type B

Section Cited

CCR

101429(a)(2)(C)(4)

Responsibility for Providing Care and Supervision for Infants

(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: (4) Initials of person who conducted each check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 11:20AM, Based on record review and interview, LPA confirmed staff are not documenting infant napping conditions during each 15 minute review. This poses a potential health and safety risk to children in care.
	POC Due Date: 02/12/2024
	Plan of Correction
1 2 3 4	Director will have staff document infant napping conditions, recording each 15 minute review with staff member's initials, by the due date (2/12/2024). Director will submit proof of correction, napping logs for each infant-age child in care, to the Department via email.

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:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FAMILY SCHOOL CDC BERNAL GATEWAY, THE	FACILITY NUMBER: 384000958
	VISIT DATE: 02/08/2024

NARRATIVE

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(Page 2)
Classrooms had smoke detector (built-in); functioning carbon monoxide detectors; and fully charged fire extinguisher (2A:10BC).

LPA reviewed facility's food preparation room/ kitchen. The food preparation room/ kitchen was observed clean and free of rubbish or trash. Infant bottles and feeding supplies were correctly stored in refrigerator. Per director, feed bottles are brought to facility, cleaned and refilled by the families daily. Per director, all food services are provided by third party vendor and delivered daily.

At 9:10AM., LPA inspected the outdoor play area. Area is completely enclosed with rubber padding installed for added safety. Outdoor play area observed clean, and was free of debris or any hazardous plants. Outdoor playthings were in good repair. Per director, for water services, staff provided children with fresh water both inside and outside.

At 9:15AM., Based on observations, LPA confirmed sandbox area does not have sufficient sand installed. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 9:35AM., LPA reviewed facility records including 5 children’s files and 6 personnel files. Staff files contained the: Notice of Employee Rights (LIC9052); Teacher Qualifications; Personnel Record (LIC701); Proof of Required immunization; and Mandated Reporter Training (AB1207).

Children’s files were reviewed and included the: Infant Needs and Services Plan, Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700), Individual Sleeping Plans (LIC9227) for qualifying infants, Updated Immunization Records; and Admissions Agreement.

At 11:20AM, Based on record review and interview, LPA confirmed staff are not documenting infant napping conditions during each 15 minute review.
(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FAMILY SCHOOL CDC BERNAL GATEWAY, THE	FACILITY NUMBER: 384000958
	VISIT DATE: 02/08/2024

NARRATIVE

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(Page 3)
At 11:30AM., Based on record review and interview, LPA confirmed facility has not conducted required emergency drill within the last 6 months.

Present staff member cardiopulmonary resuscitation / first aid certification (CPR) was current, expiring: 10/2025.

Required posting were observed in the facility including the: Facility License; Emergency Disaster Plan (LIC610); Earthquake Preparedness Checklist; Seat Beat Safety Laws; Notification of Parent’s Rights (LIC995A).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed child care centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN21-21- CCP.

LPA discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at: http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.

(REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: FAMILY SCHOOL CDC BERNAL GATEWAY, THE	FACILITY NUMBER: 384000958
	VISIT DATE: 02/08/2024

NARRATIVE

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(Page 4)
Based on today's inspection, deficiencies were cited in the areas evaluated according to the Title 22 Division 12, Chap. 1 Ca. Code of Regulations. Exit interview, plan of correction, and facility evaluation report was discussed with Director, Patricia Bacerra. Director's signature of this form acknowledges receipt of these documents.

This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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