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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001721
Report Date: 04/15/2022
Date Signed: 04/15/2022 12:46:59 PM


Document Has Been Signed on 04/15/2022 12:46 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:SFCCD-MISSION COMMUNITY COLLEGE CENTERFACILITY NUMBER:
384001721
ADMINISTRATOR:MARIA VILLASANAFACILITY TYPE:
850
ADDRESS:1125 VALENCIA STREETTELEPHONE:
(415) 920-6200
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:40CENSUS: 1DATE:
04/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Inna Plamadeala TIME COMPLETED:
01:00 PM
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On 4/15/2022 at 8:45A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Lead Teacher, Inna Plamadeala. Purpose of the inspection was explained and was for an unannounced, Annual/ Random inspection. Per Lead Teacher, site director will not be present today’s during inspection. Present was the Lead Teacher and 2 staff supervising one child. Child has been properly signed in. This is a preschool program which operated at the City College of San Francisco Mission Center. Preschool program consists of three classrooms: (Red Classroom, Rainbow Classroom, Blue Classroom) Lunchroom, Napping Room and an Outdoor Play Area. Per Lead Teacher, facility Days and Hours of operation are currently: Monday- Friday 8:30am- 12:30pm. Program operates on 10- month schedule. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:00 A.M., the following was observed: Classrooms inspected were clean and orderly with age-appropriate books, blocks and art supplies available for the children. Floor and ground surfaces leading to the exits were free of any obstructions. Children’s furniture and playthings inspected were in good repair. For storage of children’s belongings, individual cubbies are located in facility hallway. Classrooms had several child sized tables and chairs for snack and activities. Classrooms were equipped with sinks, accessible water fountains and large cabinets for extra storage. For napping services, napping mats are stored in napping room and labelled with pertaining child’s name. Per Lead Teacher, napping services have been temporarily discontinued. Classrooms were the proper temperature, with adequate ventilation and lighting. The shared children’s bathroom was reviewed during inspection. All bathroom fixtures tested were in proper operating condition with adequate supplies available. Staff bathroom was located outside in lobby. Cleaning detergents, supplies, spray bottles and all other toxins were made inaccessible, stored in the off-limit area. Accessible outlets and trash bins had been proper coverings. Facility had telephone service, smoke detector, carbon monoxide detector and fire extinguishers (2A10:BC). Facility’s first aid kit was reviewed 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: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2022
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 4


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: SFCCD-MISSION COMMUNITY COLLEGE CENTER
FACILITY NUMBER: 384001721
VISIT DATE: 04/15/2022
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(Page 2)

At 9:30A.M., LPA inspected facility’s outdoor play area. Area was completely enclosed with tall fencing. Outdoor playthings inspected were in good repair. Sand box covered and was free of any observable hazards. For water services, fresh water is readily available with the use of water pitchers and labelled bottles brought from home. Per Lead Teacher, water pitchers are refilled daily from a non-contained source. Climbing structure was properly anchored and the shaded rest area was accessible. Soft rubber surface has been installed underneath the play structure for added safety.

At 10:10A.M., LPA review the facility records including 7 children's files and 3 personnel files. Facility files reviewed included staff’s Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), Required Transcripts and Notice of Employee Rights (LIC9052). LPA reminded lead teacher to ensure proof of required immunization are stored in the facility file for all classroom personnel.

At 10:15A.M. Based on record review and interviews, LPA confirmed staff’s mandated reporter certifications had expired (AD1207). During inspection, Advisory Note: Technical Assistance (LIC9102) was issued.

Children's files were reviewed included children's Health History (LIC702), Identification of Emergency Information (LIC700), Notification of Parent’s Rights (LIC995) and Immunization Records. LPA reminded Lead Teacher to ensure the Consent for Medical Treatment Forms (LIC627) are signed and stored in the facility.

Staff's CPR/ First Aid certification was current, expiring on 11/2023.

LPA reminded facility to conduct and document emergency disaster drill every 6 months.

Per lead teacher, facility offers daily snack service and items are stored in facility. LPA reminded lead teacher to ensure container brought from home are properly labelled with the child’s name. Facility kitchen and all food items were reviewed during inspection. All food items inspected were current.

All of the required posting have been visibly posted facility hallway and included the facility’s License, Notification of Parents Rights (PUB393), Monthly Snack Menu and Emergency Disaster Plan (LIC610).

None of the children’s in care require medication or IMS services currently.

Facility was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated. (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: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SFCCD-MISSION COMMUNITY COLLEGE CENTER
FACILITY NUMBER: 384001721
VISIT DATE: 04/15/2022
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Incidental Medical Services (IMS) policy was discussed. 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, no deficiencies were observed in the areas evaluated, according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Lead Teacher, Inna Plamadeala and her signature of this form acknowledges receipt of these documents.



The 'Notice of Site Visit' form was provided and must remain posted for 30 days.

This report and rights to comment were discussed. 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: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4