384002096-10-25-2019-05-CC-LGOZ-BHASE2-20191025134802

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002096
Report Date: 10/25/2019
Date Signed: 10/25/2019 01:48:07 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:	NOE VALLEY NURSERY SCHOOL		FACILITY NUMBER:	384002096
ADMINISTRATOR:	BARAHONA, EVA		FACILITY TYPE:	850
ADDRESS:	5210 DIAMOND HEIGHTS BLVD.		TELEPHONE:	(415) 647-2278
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	30	CENSUS: 23	DATE:	10/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Director, Eva Barahona		TIME COMPLETED:	02:05 PM

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Licensing Program Analyst, Luis J. Gomez met with Director, Eva Barahona. The purpose of the visit was explained and is for an unannounced annual inspection. This center with a Co-op preschool program. Program operates at the clubhouse at Glenn Canyon Park next to the George Christopher Playground. Program utilizes a play/ multipurpose room, back patio area and park play structure. Hours of operation are Monday- Friday 9:00am- 12:30pm. Present is the director, 1 staff and 7 parents supervising 23 children. Facility is within capacity limits of the license. LPA Gomez toured facility with director and inspected for health and safety hazards.

At 12:00pm on October 25, 2019 LPA inspected the play/ multipurpose room, back patio and the children’s bathroom. LPA observed playroom is clean, organized and have plenty of age appropriate wooden toys, art supplies and books for the children. Playroom has a large carpet area for circle time and a children’s club house structure. Playroom has plenty of cubbies and several child size tables for activities and snack. Playroom is equipped with a locked cabinet and plenty of storage for materials and supplies. Napping mats are available for the children and stored in the closet. Director stated blankets are taken home by the children and washed weekly. Children’s bathroom, located in the playroom, is equipped with 2 toilets, and a sink. Step stools are also available for the children. Children’s bathroom is maintained clean and in good repair. All trash cans are properly covered. All cleaning supplies are keep inaccessible, and are located in the facility kitchen. There has acceptable ventilation and natural lighting. Playroom has a smoke detector, carbon monoxide detector and fully charged fire extinguisher (3A40BC). Facility has a fire alarm pull handle located by the back door. First aid kit and an emergency disaster supplies are available.

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SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NOE VALLEY NURSERY SCHOOL	FACILITY NUMBER: 384002096
	VISIT DATE: 10/25/2019

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At 12:15pm on October 25, 2019. LPA inspected back patio for safety hazards and dangerous conditions. Outdoor play area is equipped with tricycles, gliders, sand table and climbing bars. LPA inspected facility shed, which is used for storing trucks and other outdoor toys. Back Patio Area is free of debris, hazards or dangerous conditions.

At 1:05pm on October 25, 2019 LPA reviewed the children’s files and personnel files. All personnel have the mandated reporter training certification on file. Staff's CPR/ 1^st aid certification is current expiring: 12/2020. LPA advised director to document emergency disaster drills conducted at the facility.

LPA observed all required licensing information is properly posted in daycare. Director stated children bring daily meals and the program provides organic, sugar free snacks.

*Incidental Medical Services (IMS) policy was discussed.

*Director was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Director was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com)
*Director was advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts
*Director was reminded about the Provider Information Notices (PINs) on CCLD website.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. Exit interview was conducted with Eva Barahona, and her signature of this form acknowledges receipt of these documents.

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. 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 Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

LIC809 (FAS) - (06/04)

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