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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001473
Report Date: 07/27/2022
Date Signed: 07/27/2022 02:34:39 PM


Document Has Been Signed on 07/27/2022 02:34 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:ROOM TO GROW PRESCHOOL, THEFACILITY NUMBER:
384001473
ADMINISTRATOR:KRIS TAYLORFACILITY TYPE:
850
ADDRESS:3786 MISSION STREETTELEPHONE:
(415) 826-9598
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:26CENSUS: 14DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Oscar Harper, Christina Braun TIME COMPLETED:
01:00 PM
NARRATIVE
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On 7/27/2022 at 8:30AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Lead Teachers, Christina Braun and Oscar Harper. Purpose of the inspection was explained and was for an unannounced; annual random inspection. Present in facility were four staff supervising 14 children. Children had been properly signed in. Preschool program utilizes one classrooms and one outdoor play area. Days and hours of operation are Monday- Friday 8:00am- 5:00pm. Program operates year-around. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 8:45AM., the following was observed: classroom was clean, orderly, and with age-appropriate playthings available for the children. Floor and ground surfaces were free of obstructions. Children’s furniture, books and supplies inspected were in proper repair. LPA observed individual bins and coat hangers for storage of children's belongings. Facility had child sized tables and chairs for snack and planned activities. For napping services, foldable mats are stored in facility. Per teacher, napping supplies are washed weekly. Children’s bathroom was reviewed during inspection. Fixtures tested were in operating condition. Children’s sinks had supplies available for handwashing. Staff bathroom is located separately. Classroom was the proper temperature, with ventilation, and lighting. Trash bins and outlets are properly covered. Facility had functioning telephone service, carbon monoxide detector, and two fully charged fire extinguisher; 2A:10BC. Per Teacher, smoke detector is built into the building. First aid kit was review 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: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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 6


Document Has Been Signed on 07/27/2022 02:34 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: ROOM TO GROW PRESCHOOL, THE
FACILITY NUMBER: 384001473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review; interview; and observations, LPA confirmed staff member (S5) assisting without criminal record clearance or facility association on file. This poses an immediate health and safety risk to children in care.
POC Due Date: 08/01/2022
Plan of Correction
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Facility will ensure all staff working with children receive criminal record clearance and association prior to presence in the facility. Registered families will sign the 'Notice of A Type Deficiency' (LIC9224) prior to due date: 8/1/2022.

Civil penalty of $200.00 was issued.

Proof of correction will be submitted to the Department via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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: ROOM TO GROW PRESCHOOL, THE
FACILITY NUMBER: 384001473
VISIT DATE: 07/27/2022
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(Page 2)
At 9:05AM., LPA inspected the outdoor play area. Area was completely enclosed, with adequate shading available. Play structure was properly anchored. Sand was installed to absorb potential falls. Sand box was free of foreign objects. Water services are provided with use of labeled bottles, brought by families. Per teacher, bottles are refilled in near by sink.

Program provides daily snack services for children in care. Food items and prep area was reviewed during inspection. Children's medication, and stored IMS plan was reviewed.



At 9:30AM., LPA review the facility records including ten children's files and four personnel files. Staff files were reviewed and included: Declaration to Report Suspected Child Abuse (LIC9108); Required Transcripts; and Notice of Employee Rights (LIC9052).

LPA reminded teacher to ensure staff's proof of required immunization are stored in the facility files. Advisory Note: Technical Assistance (LIC9102TA) was issued.

At 10:00AM., Based on record review, LPA confirmed staff’s current mandated reporter training certifications (AB1207) missing from the facility files. During inspection Advisory Note: Technical Violation (LIC9102TV) was issued.

At 10:15AM., Based on record review; interview; and observations, LPA confirmed staff member (S5) assisting without criminal record clearance or facility association on file.

Children's files reviewed and included: Health History (LIC702); Identification of Emergency Information (LIC700); Consent for Medical Treatment (LIC627); Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

Staff had their current CPR (Cardiopulmonary Resuscitation)/ First Aid certification expiring 8/30/2023. Per Teacher, disaster drill was last conducted on 4/7/2022; Drill is properly logged.



Required posting were posted and include: Childcare License, Notification of Parents Rights (PUB393); Updated Emergency Disaster Plan (LIC610); LPA advised teacher to e updated snack menus and posted in visible location (one week in advance).
(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: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: ROOM TO GROW PRESCHOOL, THE
FACILITY NUMBER: 384001473
VISIT DATE: 07/27/2022
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(Page 3)
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, deficiencies were observed in the areas evaluated, according the Title 22 Division 12 Ca. Code of Regulations and cited on 809D. Exit interview, appeal rights and plans of correction was discussed with Teacher, Oscar Harper and signature of this form acknowledges receipt of these documents.



Type “A” violations were issued today. Facility is advised to provide a copy of the Evaluation Report and the Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all Children's files.

LPA issued $200.00 civil penalty during inspection.

The 'Notice of Site Visit' and Facility Evaluation Report must remain posted for 30 days. Reports will be sent to facility via email.

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: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC809 (FAS) - (06/04)
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