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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001489
Report Date: 06/13/2023
Date Signed: 06/13/2023 05:24:59 PM


Document Has Been Signed on 06/13/2023 05:24 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:KAI MING HEAD START-NORTH BEACH CENTERFACILITY NUMBER:
384001489
ADMINISTRATOR:LEE, NESANNAFACILITY TYPE:
850
ADDRESS:1170 COLUMBUS AVENUETELEPHONE:
(415) 931-1088
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94133
CAPACITY:40CENSUS: 32DATE:
06/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Nesanna LeeTIME COMPLETED:
04:20 PM
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On June 13, 2023 at approximately 1:30pm, Licensing Program Analyst (LPA) Ly conducted an Unannounced Required - 1 Year Visit at and met with Site Manager, Nesanna Lee during the visit. Purpose of the inspection was explained. There were 8 staff members including the Site Manager caring for 32 children . Teacher to child ratios were met on this day. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The center uses an electronic sign in/out system for parents to sign their children in and out of the program.

LPA and Site Manager inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Per the Site Manager, there are no firearms or weapons in the center. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in backpack inaccessible to children. LPA reviewed medication procedures with Site Manager. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. The center provides breakfast, lunch and snack and has a vendor Chefable to cater food for children. Menus are posted in the center. All solid waste storage containers have tight fitting lids. Drinking water is provided indoor and outdoor by disposable cups.

LPA and Site Manager also toured the outdoor play area for Health and Safety Hazards. LPA observed outdoor equipment is in good condition, free from loose, sharp or pointed parts. The play structure appears to be age appropriate for children in care. Areas under slides and other climbing equipment is adequately cushioned. Last Emergency Drill was conducted on 06/09/2023 and properly logged.

On this day, LPA reviewed a random sample of children's files and staff’s files were and found all files are complete. At least one staff have current Pediatric First Aid and CPR. Facility has posted all the required licensing forms in a prominent visible location.

CONTINUED>>>
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
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: KAI MING HEAD START-NORTH BEACH CENTER
FACILITY NUMBER: 384001489
VISIT DATE: 06/13/2023
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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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Facility was also informed 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.

LPA discussed Child Abuse Mandated Training AB1207 with the Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

An Exit Interview was conducted with Site Manager. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and appeal rights were discussed and left with Site Manager whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm-
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2