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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001263
Report Date: 05/16/2019
Date Signed: 05/16/2019 12:32:57 PM

COMPREHENSIVE INSPECTION
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:JCCSF HELEN DILLER FAMILY PRESCHOOLFACILITY NUMBER:
384001263
ADMINISTRATOR:SANDRA OSBORNEFACILITY TYPE:
850
ADDRESS:3200 CALIFORNIA STREETTELEPHONE:
(415) 292-1291
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY:175CENSUS: 167DATE:
05/16/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Karla CianciTIME COMPLETED:
12:40 PM
NARRATIVE
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An required annual comprehensive inspection was conducted today. Analyst toured the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The following was observed today:
Waivers\exceptions on file include electronic sign in/out and sharing of outdoor space (no more than 57 children on the outdoor space at a time).
Deficiencies cited over the past twelve months was reviewed. Director Karla Cianci Is continuing to work with staff to ensure there is adequate direct visual supervision of children at all times.
Current facility director/site supervisor is Karla Cianci
Current designated applicant for the license is Pam Schneider, however, LPA Schnell learned during today's inspection that she is no longer in her position . LPA is requesting the corporation designate a new applicant/licensee representative to represent the corporation for licensing purposes. LPA provided a list of required documentation needed to report the change.
This facility provides IMS. A review of storage of medications, equipment and supplies, and reviewed children, personnel and administrative records.

Staff immunization are on file. Director was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Influenza Declarations were also reviewed.

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: JCCSF HELEN DILLER FAMILY PRESCHOOL
FACILITY NUMBER: 384001263
VISIT DATE: 05/16/2019
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The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures (smoke and carbon monoxide detectors present and in working order), Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation, Parents Rights, and Reporting Requirements. Posting requirements for site visits were also discussed as well as AB 633 requirements. Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov

The following items need to be completed and returned to Licensing by 06/28/19:
-PERSONNEL REPORT (LIC 500)
-EMERGENCY DISASTER PLAN (LIC 610)
-ADMINISTRATIVE ORGANIZATION (LIC 309) (currently Rose Shannon is designated)
-DIRECTOR INFORMATION IS NEEDED FOR KARLA: PERSONNEL RECORD (LIC 501), HEALTH SCREENING REPORT (LIC 503), IMMUNIZATION RECORD FOR MEASLES, PERTUSSIS AND INFLUENZA DECLARATION, LETTERS OF EXPERIENCE FROM PREVIOUS EMPLOYERS, TRANSCRIPTS/DEGREE/VALID CHILD DEVELOPMENT PERMIT, SIGNED STATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT SUSPECTED CHILD ABUSE, SIGNED NOTICE OF EMPLOYEE RIGHTS AND CRIMINAL RECORD STATEMENT, PROOF OF COMPLETION OF 16 HOURS PREVENTATIVE HEALTH PRACTICES, INCLUDING CPR AND FIRST AID.

-Director was advised of Pesticides training. For More information about changes to the Healthy Schools Act, templates, articles, and required training you can inspect the DPR website at: https://apps.cdpr.ca.gov/schoolipm/childcare/training/main.cfm
-Director was informed about the Provider Information Notices (PINs) on CCLD website.
-Director was reminded of Mandated Reporter Training available on CCLD website. Training must be renewed every two years.
No deficiencies cited today.
"NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019
LIC809 (FAS) - (06/04)
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