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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001017
Report Date: 04/20/2022
Date Signed: 04/20/2022 01:49:27 PM


Document Has Been Signed on 04/20/2022 01:49 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:MISSION HEAD START-BERNAL DWELLINGS CHILDCARE CTR.FACILITY NUMBER:
384001017
ADMINISTRATOR:SHALEK L. CHAPPILLFACILITY TYPE:
850
ADDRESS:3125 - 3141 26TH STREETTELEPHONE:
(415) 826-1653
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:40CENSUS: 36DATE:
04/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Monica AlfaroTIME COMPLETED:
02:00 PM
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On 4/20/2022 at 8:45A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Lead Teacher, Monica Alfaro. Purpose of the inspection was explained and was for an unannounced, Annual/ Random inspection. Present was the Lead Teacher and 8 staff supervising 36 children. All children present were properly signed in. Preschool program utilizes three classrooms: Quetzal Classroom (3- 5 years old), Estrellitas Classroom (Toddler, 1.5- 3 years old), Mariposas Classroom (Toddler, 1.5- 3 years old), and two shared, Outdoor Play Spaces. Days and hours of operation are Monday- Friday 8:00am- 5:30pm. Preschool program operates year around. LPA inspected facility, indoors and outdoors, with lead teacher for health and safety hazards.

At 9:00 A.M., the following was observed: Classrooms inspected were clean and orderly with age-appropriate books, blocks and art supplies available for the children. Floor and ground surfaces leading to the exits were free of any obstructions. Children’s furniture and playthings inspected were free of sharp or pointed parts. For storage, classrooms were equipped with individual cubbies for children's belongings. Each classroom had child tables and several chairs for snack and activities. For napping services, labelled napping mats are stored in each classroom and with the pertaining child’s name. Per lead teacher, children’s napping sheets are washed by staff weekly. Toddler classroom were equipped with diaper changing tables, which is sanitized by staff after each use.

The children’s bathrooms were reviewed during inspection. Bathroom fixtures all were in proper operating condition. Children's bathrooms had adequate supplies available. Staff’s bathroom is in the facility hallway. Classrooms had the proper temperature, with ventilation and lighting. Cleaning detergents, supplies, spray bottles and all other toxins were made inaccessible. Accessible outlets and trash bins had been properly covered. Facility had functioning telephone service, smoke detector, carbon monoxide detector and fully charged fire extinguishers (3A:40BC). First aid kits were review by LPA during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
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 5


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: MISSION HEAD START-BERNAL DWELLINGS CHILDCARE CTR.
FACILITY NUMBER: 384001017
VISIT DATE: 04/20/2022
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(Page 2)

At 9:30A.M., LPA inspected facility’s outdoor play areas #1, #2. Spaces were completely enclosed with tall fencing and free of any loose debris.

At 9:35A.M., Based on observation, LPA confirmed an accessible Aloe Vera plant, located in the outdoor play area. During inspection, Advisory Note: Technical Assistance (LIC9102) was issued.

Outdoor playthings inspected were in good repair. Sensory tables did not have any observable hazards. For water services, refillable water pitchers and cups are taken outside. Per lead teacher, water pitchers are refilled by staff from a non-contained source. Soft padding had been installed on ground to absorb potential falls. LPA reminded lead teacher that the shaded rest area must remain accessible to children at all times.

At 9:45A.M., LPA review the facility records including 10 children's files and 9 personnel files. Facility files reviewed included staff’s Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), Required Transcripts, Notice of Employee Rights (LIC9052) and Proof of staff immunization.

LPA reminded Lead Teacher to ensure all classroom personnel have their current mandated reporter training certifications in the facility files. During inspection, Advisory Note: Technical Assistance (LIC9102) was issued.

Children's files reviewed were complete. Forms in children’s files included the children's Health History (LIC702), Identification of Emergency Information (LIC700), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995) and Immunization Records.

On-site staff had their current Cardiopulmonary resuscitation/ First Aid certification on file, expiring on 11/2023. Facility is conducting emergency drills every six months, with the last drill done on, 3/23/2022, properly logged.

Per lead teacher, program families with daily lunch and snack services. LPA reminded director to ensure container brought from home are properly labelled with the child’s name. Facility kitchen and food was reviewed during inspection. Food items inspected were current and properly stored.

Required posting are posted outside and included the: Childcare License, Notification of Parents Rights (PUB393), and Updated Emergency Disaster Plan (LIC610). LPA reminded lead teacher to post the lunch schedule and updated for families at least one week prior. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: MISSION HEAD START-BERNAL DWELLINGS CHILDCARE CTR.
FACILITY NUMBER: 384001017
VISIT DATE: 04/20/2022
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(Page 3)

During inspection, LPA reviewed children’s medication and IMS plans on file. All medication inspected was current and in its original packaging.

Lead teacher 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.

LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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

Based on today's inspection, no deficiencies were observed in the areas evaluated, according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Lead Teacher, Monica Alfaro and her signature of this form acknowledges receipt of these documents.



The 'Notice of Site Visit' was provided and must remain posted for 30 days.

This report and rights to comment were discussed. This report must be available in the facility for public review. For additional questions, facility was advised to contact the Community Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5