384001017-6-26-2024-05-CC-LGOZ-D6LQ94-20240626115744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001017
Report Date: 06/26/2024
Date Signed: 06/26/2024 11:58:25 AM

Document Has Been Signed on 06/26/2024 11:58 AM - 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:	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: 21	DATE:	06/26/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Maria Villalobos		TIME COMPLETED:	12:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/26/2024 at 8:30AM., Licensing Program Analyst (LPA), Luis Gomez met with Director, Maria Villalobos. The purpose of today's inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed preschool program with toddler option. Present was the director and 8 staff supervising 21 children. Children present have been signed in by Guardians. Personnel have criminal record clearances on file. The 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. Outdoor Space Waiver for rotational use was observed during inspection. LPA inspected facility with director for health and safety hazards. At 8:40AM., LPA observed the following: Classrooms were clean and neat, with age-appropriate materials and supplies available for the children. Walkways and floors were clear of any obstructions. Classrooms were equipped with children tables and chairs, scaled to the proper size. For storage, cubbies are available in each classroom. The children’s bathroom area was observed clean, with fixtures in operating condition. Two diaper changing tables, within arm’s reach of sink, are available for the staff. For disposable of solid waste, trash bins are available with tight-fitting lids. Electrical outlets have been covered. For scheduled rest/ nap, the facility has cleanable plastic cots. Per staff, napping sheets and blankets are washed every on-site weekly. The classroom had adequate ventilation, lighting, and were a comfortable temperature. Facility has a functioning telephone service; carbon monoxide (CO) detector; smoke detector (Built-in) and fire extinguishers: 3-A:40B:C. The cleaning compounds, detergents, medications, and other items which could pose a danger, have been stored inaccessible to children. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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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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: MISSION HEAD START-BERNAL DWELLINGS CHILDCARE CTR.	FACILITY NUMBER: 384001017
	VISIT DATE: 06/26/2024

NARRATIVE

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At 9:15AM, LPA inspected the outside play area. Area was completely enclosed with tall fencing. Playthings inspected were in good repair. Water services are readily available from non contaminated water fixture inside and outside, with refillable pitcher and water cups. Facility shed was reviewed during inspection.

The food preparation/ storage areas were reviewed during inspection. Per director, facility provides children with breakfast, lunches, and snacks (morning, afternoon). Food items inspected were current and properly stored.

At 9:30AM., LPA reviewed facility records including children and personnel files. The personnel files were reviewed and contained staff’s Proof of Teacher Qualifications; Proof of required immunization; Notice of Employee Rights (LIC9052); Acknowledgement to Report Suspected Child Abuse (LIC9108); and Personnel Record.

LPA advised director to ensure staff's proof of completed 'Mandated Reporter Training' (AB1207) course is stored in staff files. Advisory Note: Technical Violation (LIC9102TV) was issued.

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

Staff’s Cardiopulmonary Resuscitation / First Aid certification was current and expires on: 8/2024.

Facility is conducted required emergency disaster drills every six months, with last drill (Fire Drill) completed on: 6/12/2024.

LPA observed required postings including the: License; Notification of Parent’s Rights (PUB394); Passenger Safety Laws (PUB269); Food Service Menu (June); and Emergency Disaster Plan (LIC610). (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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: MISSION HEAD START-BERNAL DWELLINGS CHILDCARE CTR.	FACILITY NUMBER: 384001017
	VISIT DATE: 06/26/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

LPA referred Director to the Department website regarding Lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chapter 1 Ca. Code of Regulations. Exit interview reviewed the facility evaluation report was discussed with Director, Maria Villalobos. Administrator’s signature on this form acknowledges receipt of these documents.

This report must be made available in facility for public review. Notice of site visit was given and must remain posted for 30 days. Director was advised, any additional questions/ concerns to contact the office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC809 (FAS) - (06/04)

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