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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002040
Report Date: 01/15/2020
Date Signed: 01/15/2020 01:09:29 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:ST.THOMAS THE APOSTLE PRE&K LRNG CTRFACILITY NUMBER:
384002040
ADMINISTRATOR:MEN, JIA JUNFACILITY TYPE:
850
ADDRESS:710 - 40TH AVENUETELEPHONE:
(415) 387-5511
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:75CENSUS: 60DATE:
01/15/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jessie Men TIME COMPLETED:
11:40 PM
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the Site Director, Jessie Men. The purpose of the inspection was explained to her. There were 60 children with 12 staff present. The facility is located at the St. Thomas The Apostle Church. The church has Elementary and Preschool programs. The entrance of the preschool is on 40th Avenue. The operation hours of the facility are Monday to Friday from 7:45am to 5:45am. The facility runs the preschool program in 3 classrooms (younger 3 yrs old, Older 3 years old, and Pre-K). LPA toured and inspected the facility for health and safety hazard. The facility was clean and in order. Temperature and lighting were adequate. Toxins and harmful objects were either locked or made inaccessible to the children. All electrical outlets were covered. The sharp corners were covered, Right amount of cubbies were available for the children to store own belongings. There were plenty of age-appropriate toys, books, learning material, and children's furniture available for children. All equipment and furniture were in good condition. Children's bathroom has two toilets, three urinals and 5 faucets. Separated staff bathroom is available for staffs. Children bring their own lunch and the facility provides snacks only for children. Parents are also have an option to order the Elementary School lunch for their children and delivered to the center during the regular semester. First aid supplies are available for children in each classroom at the center. Sick children will be separated from the group and place in the Director's office while waiting for their parents to pick up. Mats were used as the napping equipment. Facility has its own outdoor play area in the back of the property. The yard was completely fenced and separated from the Elementary school. There were plenty of age-appropriate outdoor toys, sand box, play structure with soft cushioning underneath and play houses. At least one staff on site has current CPR and First Aid training. It will expire in 3/2021. Per Site director, there were no children on special medication. 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. All required postings were posted. Children files and roster were reviewed during the inspection. LPA also obtained a copy of the personnel report and children roster from licensee during the inspection.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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