384002096-9-4-2025-05-CC-CQUO-DL7UMM-20250904154233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002096
Report Date: 09/04/2025
Date Signed: 09/04/2025 03:42:41 PM

Document Has Been Signed on 09/04/2025 03:42 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	NOE VALLEY NURSERY SCHOOL		FACILITY NUMBER:	384002096
ADMINISTRATOR/ DIRECTOR:	OLDENBURG, ZAC		FACILITY TYPE:	850
ADDRESS:	5210 DIAMOND HEIGHTS BLVD.		TELEPHONE:	(415) 647-2278
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 19	CENSUS: 6	DATE:	09/04/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:15 PM
MET WITH:	Zachary Oldenburg		TIME VISIT/ INSPECTION COMPLETED:	03:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 4, 2025 at approximately 1:15pm, Licensing Program Analysts (LPAs) Catrina Quimbo and Leslit Tapia-Mandujano, conducted an unannounced, annual inspection to Noe Valley Nursery School. LPAs met with teacher, T1, and explained the purpose of the visit. Upon LPAs' arrival, children were resting in the classroom and director was on their lunch break. At approximately 1:20pm, director arrived to facility. LPAs continued annual inspection with director. Present during LPAs' visit included 6 preschool children, T1 and director. Teacher to child ratio was met during today's visit. T1 and director have fingerprint clearance on file. Program operates as a cooperative nursery (co-op) school that operates Monday through Friday 9:00am to 12:30pm. After hour care is available from 12:30pm to 3:30pm on Tuesdays, Wednesdays and Thursdays with a fully qualified teacher and director. Per director, there are 3 to 4 parent volunteers daily with a total of 19 children. There is a sign in/out sheet that documents the parent volunteers daily. Per director, each parent volunteer has a responsibility/role in the classroom. With director, LPAs inspected facility for health and safety hazards. Facility is appropriately ventilated with proper temperature. LPAs observed facility to have a variety of toys, equipment and furniture that are in good condition and age appropriate. Facility includes areas for art, dramatic play, gross motor development, and circle time. Per director, toys and materials are sanitized monthly or as needed. There is a loft in the classroom with a ladder that sustains the weight of an adult. There is also an indoor play structure that is secure. Indoor play structure includes resilient padding underneath. Flooring in classroom includes rugs that were observed to be clean. Per director, rugs are vacuumed daily and floor is mopped twice a week. Storage for children's belongings are located inside the classroom with children's names. Classroom is equipped with a fully charged fire extinguisher, first aid kit, smoke alarm and carbon monoxide detector. Carbon monoxide detector was testing during today's visit and observed to be working. There is a working sink the classroom for hand washing only. LPAs observed cabinets by hand washing sink to have child safety locks installed. (Continue Report on Page 2...)

Marie Rodriguez
Catrina Quimbo
	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NOE VALLEY NURSERY SCHOOL	FACILITY NUMBER: 384002096
	VISIT DATE: 09/04/2025

NARRATIVE

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Due to program being a co-op, food service is provided by enrolled children's authorized representatives daily. Food is prepared in kitchen and distributed to children. LPAs observed children's allergies to be posted in kitchen, available for review. Cleaning solutions are stored in a high shelf, separate from where food items' materials can be stored. LPAs observed knives in kitchen to be in a high shelf. Reusable utensils and plates are utilized for food service that are washed, soaked and air dried daily.

Drinking water is available through children's individual water bottles. Children's water bottles can be refilled on site through the kitchen's sink or a filtered water pitcher (also refilled through kitchen's sink). There is a water fountain in the classroom that is not in working condition.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Restroom for children's use was observed to be in working condition. Children's restroom is public, however, is locked from the public during co-op's hours of operation. LPAs observed children's restroom to be in proper working condition, equipped with age appropriate toileting equipment. Per director, no children are in diapers. Per director, children are to be fully potty trained prior to enrollment. Per director, children's restrooms are cleaned daily.

On site outdoor area is fully enclosed and fenced. There are a variety of toys and equipment in the outdoor area that are stored away and covered, when not in use. Outdoor toys and materials were observed to be in good condition. LPAs did not observe any pools, spas or bodies of water on site.

Children are signed into and out of program by children's authorized representatives' written signatures. Licensing documentation is properly posted and available for review. A childcare roster was made available for review.

LPA reviewed facility records that included 5 random children's files, director's file and 2 teaching staffs' files. Children's files have record of emergency information on file. All teaching staff have a current CPR/First Aid certification as well as a current Mandated Reporter certifications. Teaching staff also have their required educational requirements on file and available for review. LPA also observed parent volunteers to have immunizations and health screening reports available for review.
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SUPERVISOR'S NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NOE VALLEY NURSERY SCHOOL	FACILITY NUMBER: 384002096
	VISIT DATE: 09/04/2025

NARRATIVE

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Emergency disaster drill has not yet been conducted this school year. Facility closed for summer break May 2025. Facility reopened August 2025 and is scheduled to be conducted. LPA reminded director emergency disaster drills are to be conducted and documented at least once every six months. A technical violation was issued.

Children who stay after hours have the opportunity to rest and nap in the classroom. Floor mats are utilized for napping children. Sheets and blankets are provided by children's families and are sent home monthly, or as needed, for laundering. LPAs observed children's mats, sheets and blankets to be stored appropriately when not in use, to avoid touching each other.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inforesources/community-care-licensing/inspection-process

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at:https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Zachary Oldenburg.

SUPERVISOR'S NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC809 (FAS) - (06/04)

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