384001117-3-19-2024-05-CC-JTSE-D3HVLX-20240319163239

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001117
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:33:06 PM

Document Has Been Signed on 03/19/2024 04:33 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:	CCFC-MARY LANE INFANT AND TODDLER CENTER		FACILITY NUMBER:	384001117
ADMINISTRATOR:	CRUZ, ERICKA		FACILITY TYPE:	830
ADDRESS:	ONE WEBSTER STREET		TELEPHONE:	(628) 233-6848
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94117
CAPACITY:	28	CENSUS: 15	DATE:	03/19/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Director, Erica Ngo		TIME COMPLETED:	04:45 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 3/19/2024, at approximately 1:20PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Director, Erica Ngo (D1). LPA explained the purpose of the visit to D1. Present during the visit was D1, eight staff members, and 15 infant children. The facility is in compliance with staffing and ratio requirements on this day. LPA inspected the facility for any health and safety hazards. There are three rooms for children in care: Young Infants, Mobile Infants, and Young Toddlers. LPA observed the facility to be in clean and orderly condition. All electrical outlets are covered or obstructed by furniture to be inaccessible to children in care. There are cubbies for each child that are labeled. Each room is equipped with a carbon monoxide detector. There is a fully charged fire extinguisher present. All garbage cans are equipped with tight-fitting lids. There is comfortable heating and ventilation in the facility that can be adjusted. Sign-in/out sheets are present in each room for parents. LPA observed a napping room within the Young Infants room and found that there was at least one crib available for each infant present. The Young Infants room had furniture and equipment with smooth, rounded edges. Toys and learning materials are age appropriate. LPA observed the first aid kit to be complete. There is infant formula present, which is provided by the facility. The Mobile Infant room is separated from the Young Toddler room by a shared children’s bathroom and teacher workstation. Both the Mobile Infant room and the Young Toddler room contain mats for infants to nap on. Blankets and bedding are provided by the facility and washed once a week. LPA observed a washing machine and a drying machine to be present in the teacher workstation. The teacher workstation is inaccessible to children in care. There are two first aid kits present in the workstation. There are two infant changing stations in the shared children’s bathroom, with a hand washing sink between them. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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: CCFC-MARY LANE INFANT AND TODDLER CENTER	FACILITY NUMBER: 384001117
	VISIT DATE: 03/19/2024

NARRATIVE

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LPA observed the outdoor play area to be free of debris and other loose articles. There is a sandbox area present, which is covered at the end of the day. Per D1, the sandbox is checked daily for animal droppings. There are age-appropriate toys and equipment for children in care. The facility maintains a first aid kit in the outdoor play area that is accessible for staff.

LPA reviewed five staff files and five children’s files. LPA observed staff members to be fully qualified for infant care. Upon review of the facility’s Guardian roster, LPA observed that D1 was not associated to the facility. D1 has a criminal record clearance and LPA was able to associate them to the facility. See LIC809-D for deficiency cited and cleared on this day, 3/19/2024. LPA found all children’s files to be complete and all files included a Needs and Services Plan. All required postings are posted and accessible for review in the main hallway of the facility.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

D1 was reminded that all adults 18 and over, 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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: CCFC-MARY LANE INFANT AND TODDLER CENTER	FACILITY NUMBER: 384001117
	VISIT DATE: 03/19/2024

NARRATIVE

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LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA discussed the safe sleep regulations with D1 and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/.

D1 was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

See LIC809-D for deficiency cited and cleared today, 3/19/2024. See LIC9102-TV for technical violation issued related to safe sleep regulations. See LIC9102-TA for technical assistance given related to safe sleep. Appeal rights were provided and explained to D1.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Erica Ngo.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC809 (FAS) - (06/04)

Page: 3 of 6

Document Has Been Signed on 03/19/2024 04:33 PM - It Cannot Be Edited

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: CCFC-MARY LANE INFANT AND TODDLER CENTER	FACILITY NUMBER: 384001117
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/20/2024
	Plan of Correction
1 2 3 4	D1 was associated to the facility during the visit. This deficiency shall be cited and cleared on the same day of the visit, 3/19/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC809 (FAS) - (06/04)

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