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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001634
Report Date: 08/22/2019
Date Signed: 08/22/2019 12:22:37 PM

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:MISSION HEAD START - VALENCIA GARDENSFACILITY NUMBER:
384001634
ADMINISTRATOR:THERESA SANCHEZFACILITY TYPE:
850
ADDRESS:380 VALENCIA STREETTELEPHONE:
(415) 552-0169
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:36CENSUS: 32DATE:
08/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Site Supervisor, Melva Bosley TIME COMPLETED:
12:30 PM
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Licensing Program Analysts, Luis J. Gomez met with Site Supervisor Melva Bosley. The purpose of the visit was explained and is for an annual inspection. The PreK program operates year-round and uses 2 classrooms (Tigers and Giraffes), and 1 outdoor play areas. Hours of operation are Monday- Friday 8:00am- 5:30pm. Present are the site supervisor and 8 staff supervising 33 children. LPA Gomez observed licensing forms are posted next to the main to door including outdoor space waiver and Children’s meal menu. Facility was inspected indoors and outdoors for Health and Safety hazards. Classrooms clean, orderly and equipped with age appropriate toys, puzzles, blocks, books and equipment that are in good repair. Each classroom has an art area, dramatic play area and child size tables and chairs available for the children. There are children’s bathroom are located in each of the two classes. Each of the children’s restroom is equipped with 2 child size toilets and 2 child size sinks. Bathrooms are maintained clean, in good repair, and with adequate supplies. Staff use a separate restroom located outside the office. At 9:10, on August 22, 2019, LPA Gomez observed the parent’s sign-in sheet did not match the number of children present in classroom #1(Tigers). Classrooms have acceptable ventilation and ample lighting. Each classroom is equipped with a smoke detector, carbon monoxide detector and a fire extinguisher. Each classroom has first aid kit and emergency supplies that are properly maintained and kept inaccessible to children. All cleaning products, detergents and toxins are maintained inaccessible to children by child safe locked above the sink. Emergency drills are done monthly, with the last drill conducted on July 7, 2019, properly logged. Program utilizes 1 outdoor play areas, which is accessible from each of the classrooms. LPA Gomez inspected outdoor play areas for safety hazards and dangerous conditions. LPA Gomez observed the outdoor play area is equipped with a toys, blocks and bikes for children. Entire outdoor area is enclosed with gated fencing. Drinking water is readily available indoors and outdoors children. LPA Gomez inspected the children’s medication and observed all medication is current and up-to-date. Site Supervisor stated that all snacks and meals are provided daily by Better 4 You.

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SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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 3
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: MISSION HEAD START - VALENCIA GARDENS
FACILITY NUMBER: 384001634
VISIT DATE: 08/22/2019
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LPA Gomez review facility Personnel Files, Children’s Roster and Children’s Files during today’s inspection. LPA Gomez observed several employees were missing the required mandated reporter training certification in their staff files. LPA Gomez observed children's files and Roster are complete and up-to date. Staff’s CPR/ 1st Aid Certification is current, expiring in 11/2019.

Incidental Medical Services (IMS) policy was discussed. 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



Site Supervisor 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. Site supervisor was informed about the Provider Information Notices (PINs) on CCLD website.


Based on today's inspection, deficiencies were observed in the areas evaluated and cited according to the Title 22 Division 12 of the Ca. Code of Regulations listed on the 809-D. Plan of corrections were developed and discussed with Site Supervisor Melva Bosley. An exit interview was conducted and a copy of the appeal rights was provided to Melva Bosley and her signature to this form acknowleges the receipt of these documents.

Notice of site inspection was posted.
Site Supervisor was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MISSION HEAD START - VALENCIA GARDENS
FACILITY NUMBER: 384001634
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2019
Section Cited
CCR
101229.1(a)
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101229.1 Sign In Sign Out. Licensee shall develop, maintain, and implement a written procedure to sign the children in/out of the child care center... This requirement is not met as evidenced by
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Site Supervisor will submit a written plan to LPA Gomez on how facility will ensure staff, parents and guardians follow the proper sign-in procedures during child drop-off and pick-up times by the due date: 09/05/2019

Supervisor will submit proof of correction to LPA Gomez via email.
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Based on observations, interview and file review, LPA Gomez confirmed that the number of children present did not match the facilities sign-in log. This is a potential health and safety risk to children in care.
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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: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
LIC809 (FAS) - (06/04)
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