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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001824
Report Date: 10/11/2022
Date Signed: 10/11/2022 04:19:15 PM


Document Has Been Signed on 10/11/2022 04:19 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:STEIN, SARAH E.FACILITY NUMBER:
384001824
ADMINISTRATOR:STEIN, SARAH E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 648-1316
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:14CENSUS: 9DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Sarah Stein TIME COMPLETED:
04:30 PM
NARRATIVE
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On 10/11/2022 at 1:35PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Sarah Stein. Purpose of the inspection was explained and was for an unannounced; Annual Random inspection. Present in facility was the licensee and helper caring for nine children. All children present were preschool age. Adults have their criminal record clearances on file. Licensee’s home is a three bedroom, two bathroom, two level house. Days and hours of operation are Monday- Friday, 8:00AM- 5:00PM. Day-care area are: Living Room (Playroom); Family Room (Playroom #2); Bedroom #1 (Imagination Room); Bathroom #1; Dining Area and Outdoor Play Area. Off-limit area are: Bedroom #2, and Entire Lower Level. LPA inspected home, inside and outside, with licensee for health and safety hazards.

At 1:45PM., the following was observed: Facility was clean, orderly, with age appropriate playthings available for the children. Ground surfaces was clear of obstructions. Accessible furniture, puzzles and books inspected were in good repair. Dining Area has child sized table and chairs for snack and activities. Playroom #2 is equipped with cubbies for storage of children's belongings. For napping services, LPA observed stackable cots located in bedroom #1. Bathroom#1 had adequate supplies for hand-washing. Fixtures tested were in operating condition. Facility was the proper temperature, with ventilation and lighting. Home had functioning telephone; smoke/ carbon monoxide combination detector; and one fire extinguisher, 3A:40BC.

LPA inspected the outdoor play area. Area is completely enclosed with tall fencing. Tricycles and playthings inspected were in proper repair. Outdoor play area does not any pools, fishponds, or bodies of water on the premises.


(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: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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: STEIN, SARAH E.
FACILITY NUMBER: 384001824
VISIT DATE: 10/11/2022
NARRATIVE
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(Page 2)
At 2:15PM, LPA reviewed facility and children’s records. Staff record were reviewed and included: Proof of Required Immunization and Notice of Employee Rights (LIC9052).

At 2:20PM., Based on record review, LPA confirmed licensee 'Mandated Reporter Training certification (AD1207) is expired. Advisory Note: Technical Violation (LIC09102TV) was issued during inspection.



Children's records were reviewed and included: Children’s Emergency Information; Immunization Records; and Notification of Parent’s Rights (LIC995A).

LPA reminded licensee to have families sign the “Consent for Medical treatment’ (LIC627).



Licensee’s Cardiopulmonary Resuscitation (CPR)/ First Aid certification is current, expiring: 7/21/2023.
Licensee is conducting required emergency disaster drill, with last drill completed on 6/15/2022, properly logged.

Required posting are posted in visible location. Posting include the Childcare License, Notification Parent’s Rights (PUB379), and Emergency Disaster Plan (LIC610A).

Per licensee, isolation of ill children is in playroom #1.

Per licensee, she provides all foods services for children in care. LPA reminded licensee to ensure all children’s food containers brought by families is properly labeled. Per licensee, home does not have any firearms or weapons.

Licensee was reminded that all adults 18 years and over, living or working in the home, including employee and volunteers, must obtain criminal 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 up to $500.00 maximum per day/ per person will be assessed 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: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
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: STEIN, SARAH E.
FACILITY NUMBER: 384001824
VISIT DATE: 10/11/2022
NARRATIVE
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(Page 3)
LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will 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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in areas evaluated according to California Title 22, Health and Safety Code of Regulations. Exit interview and report was discussed with Licensee, Sarah Stein and signature of this form acknowledges receipt of these documents.



Notice of Site Visit was provided and must be posted for 30 days.

This report must be available in the facility for public review. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4