384001017-4-14-2023-05-CC-LGOZ-CQVQY2-20230414123426

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001017
Report Date: 04/14/2023
Date Signed: 04/14/2023 12:34:40 PM

Document Has Been Signed on 04/14/2023 12:34 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MISSION HEAD START-BERNAL DWELLINGS CHILDCARE CTR.		FACILITY NUMBER:	384001017
ADMINISTRATOR:	SHALEK L. CHAPPILL		FACILITY TYPE:	850
ADDRESS:	3125 - 3141 26TH STREET		TELEPHONE:	(415) 826-1653
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	40	CENSUS: 36	DATE:	04/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Maria Villalobos		TIME COMPLETED:	12:40 PM

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On 4/14/2023 at 8:40AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Maria Villalobos. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate preschool-age with toddler option. Present was the directors and 7 staff supervising 36 children. Children present had been properly signed in. Staff have criminal record clearances on file. Preschool program utilizes three classrooms: Quetzal Classroom (Preschool, 2- 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. Program operates year around. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

At 8:55PM., LPA observed the following: Classrooms were clean, orderly, with age-appropriate playthings available for the children. Ground surfaces were free of any obstructions or potential hazards. Labeled cubbies are available for storage of children's belongings. Furniture, supplies, and playthings inspected were free of sharp corners or splinters. Facility is equipped with child- sized tables and chairs for snack and seated activities. Children’s bathrooms are maintained clean, with fixtures in operating condition. Diaper changing table are available for staff. Per director, area cleaned and disinfected after each use. Staff bathroom is located separate. For napping services, labeled cots are stored in each classroom. Cots inspected were made of cleanable material. Per director, sheets are washed weekly. Classrooms had acceptable ventilation and lighting. The disinfectants and poisons have been stored inaccessible to children. Outlets and trash bins have been covered. Facility has built-in smoke detector, functioning carbon monoxide detector, telephone service, and fully charged fire extinguishers: 3A:40BC located in each classroom. First aid kit was reviewed and is fully stocked.

At 9:25AM, LPA inspected the shared outdoor play area. Outdoor play yard was completely enclosed. Outside playthings inspected were in good repair. Rubber padding had been installed for added safety. Water services, refillable bottles are provided for children outside, with pitchers and water cups. Accessible shading rest area is available.

LPA reminded director to remove accessible mouse trap, and all broken items from outdoor area. Trap was removed during inspection. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPA inspected kitchen/ food storage area. Food items inspected were current, and correctly stored. Area was clean, free of any trash or rubbish.
(REFER TO 809-C FOR CONT.)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MISSION HEAD START-BERNAL DWELLINGS CHILDCARE CTR.	FACILITY NUMBER: 384001017
	VISIT DATE: 04/14/2023

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(Page 2)
At 10:05AM LPA reviewed facility records including three children’s files and four personnel files. Staff’s files contained the: Notice of Employee Rights (LIC9052); Education Verification; Required Proof of Immunization; 'Mandated Reporter Training' certification (AB1207); and Personnel Record (LIC501).

Children’s files contained the: Consent for Emergency Medical Treatment (LIC627); Immunization Records, Identification and Emergency Information (LIC700); Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

Staff is documenting infant napping conditions, documenting each review every 15 minutes.

Staff member had their current ‘Cardiopulmonary Resuscitation and First Aid’ certification, which expires on: 4/30/2024.

Emergency disaster drill are conducted on-site, with the last drill completed on 1/17/2023, properly logged.

LPA observed required posting in facility, including the: Facility License; Notice of Parent’s Rights (PUB394); Emergency Disaster Plan (LIC610); Earthquake Preparedness Checklist; April’s Lunch Menu; Outdoor Space Waiver; and Seat Belt Safety Laws.

LPA reviewed children’s medication. ‘Incidental Medical Services’ (IMS) plans are stored in children’s files.

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.

(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISSION HEAD START-BERNAL DWELLINGS CHILDCARE CTR.	FACILITY NUMBER: 384001017
	VISIT DATE: 04/14/2023

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(Page 3)
Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations. Exit interview and Report was reviewed with Director, Maria Villalobos, and signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director 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

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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