384001609-4-15-2024-05-CC-JTSE-D4CV4B-20240415160604

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001609
Report Date: 04/15/2024
Date Signed: 04/15/2024 04:06:19 PM

Document Has Been Signed on 04/15/2024 04:06 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:	MANCASOLA-NORRIS, PIPER ANNE		FACILITY NUMBER:	384001609
ADMINISTRATOR:	MANCASOLA-NORRIS, PIPER A		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 608-2783
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94127
CAPACITY:	14	CENSUS: 9	DATE:	04/15/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Licensee, Piper Anne Mancasola-Norris		TIME COMPLETED:	04:20 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 4/15/2024, at approximately 2:05PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Piper Anne Mancasola-Norris (L1). LPA explained the purpose of the visit. Present during the visit was L1, two helpers, and nine preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:00AM to 4:45PM. Daycare Areas: Main Playroom, Playroom, Bathroom, Art Room, Backyard, Lower Deck. Off-limits Areas: Upper Deck, Garage, Upper Level of the home. LPA inspected the facility for any health or safety hazards. LPA observed the facility to be in clean and orderly condition. The facility is equipped with a combination smoke and carbon monoxide detector that L1 demonstrated to be operational. There is a fully charged 2A10BC fire extinguisher in the Main Playroom. There is a first aid kit present in the Main Playroom, in addition to first aid supplies stored in the Bathroom. Electrical outlets are covered when not in use or obstructed by furniture to be inaccessible to children in care. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children. Off-limits areas are kept inaccessible to children with childproof doorknobs or childproof gates. Per L1, there are no firearms or weapons stored in the facility. There are age-appropriate toys and learning materials present. Furniture is age-appropriate and free of rough or sharp edges. Children nap on mats and bring bedding from home. Per L1, the facility keeps bedding at the facility and cleans it once a week. Children bring water bottles from home and water is provided from a filtered source. Per L1, water bottles are kept and cleaned at the facility. Children bring lunch from home and the facility provides snacks as necessary. Each child has their own basket to store their belongings that is clearly labeled. 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: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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: MANCASOLA-NORRIS, PIPER ANNE	FACILITY NUMBER: 384001609
	VISIT DATE: 04/15/2024

NARRATIVE

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LPA observed the Backyard to be free of debris and other loose articles. The Backyard is enclosed by a fence that is at least four feet high. There is resilient padding in the form of woodchips. The stairs that lead from the Art Room to the Backyard are secured by childproof gates at both the top and the bottom. There are hand railings installed on the stairs that are lower to accommodate children in care. There are no pools or other bodies of water present in the facility. There are two dogs in the facility that are kept upstairs and are not in contact with children in care.

LPA reviewed four personnel files, five children’s files, and facility records. LPA observed all staff members to have current Mandated Reporter Training. LPA advised L1 that First Aid/CPR training shall be from the American Heart Association, American Red Cross, or an EMSA certified vendor. L1 stated that they understood. LPA observed children’s files to be complete, including Emergency Identification and Information (LIC700), Notification of Parents’ Rights (LIC995A), and immunization records. L1 provided LPA with the Facility Roster (LIC9040) during review of the facility’s records. LPA observed all required postings to be visible and accessible for review in the Main Playroom.

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.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

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: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: MANCASOLA-NORRIS, PIPER ANNE	FACILITY NUMBER: 384001609
	VISIT DATE: 04/15/2024

NARRATIVE

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LPA discussed the safe sleep regulations with Licensee 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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

Licensee 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.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited during today’s visit on 4/15/2024. See LIC9102-TA for technical assistance provided today regarding accepted First Aid/CPR training.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Piper Anne Mancasola-Norris.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

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