384002096-10-3-2022-05-CC-CQUO-CJUSKZ-20221003135731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002096
Report Date: 10/03/2022
Date Signed: 10/03/2022 01:58:15 PM

Document Has Been Signed on 10/03/2022 01:58 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:	NOE VALLEY NURSERY SCHOOL		FACILITY NUMBER:	384002096
ADMINISTRATOR:	BARAHONA, JOHANA		FACILITY TYPE:	850
ADDRESS:	5210 DIAMOND HEIGHTS BLVD.		TELEPHONE:	(415) 647-2278
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	30	CENSUS: 15	DATE:	10/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Johana Barahona		TIME COMPLETED:	02:30 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 October 3, 2022 at approximately 12:20pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with director, Johana Barahona, and explained the purpose of the inspection. Facility is a co-op program that operates part time from Monday to Friday 9:00am to 12:30pm. Extended hours are available if needed. Facility operates in the clubhouse at Glenn Canyon Park. Present during LPA's visit included director, co-teacher and 3 volunteers/parents of enrolled children, and 15 enrolled children (preschool age). Facility is currently operating within teacher to child ratio limits during LPA's visit. With director, LPA inspected facility for health and safety hazards. LPA observed club house to be clean with age appropriate toys, materials and furniture. Club house is appropriately ventilated with proper temperature. Storage for children's belongings are located inside the classroom, labeled with each child's individual names. Classroom is separated into multiple sections that include areas for dramatic play, quiet time, motor skill development and eating. Facility is equipped with a fully charged fire extinguisher, multiple carbon monoxide detectors and a fire system implemented. Club house also includes a kitchen that is off limits to enrolled children. LPA observed all poisons, cleaning supplies and other hazardous materials to be properly stored in an off limit area and/or locked behind child safety locked cabinets. Facility operates as a co-op program. Food service is provided by enrolled children's parents and/or authorized representatives. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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: 10/03/2022

NARRATIVE

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LPA observed outdoor area to be fully fenced. Outdoor area is equipped with age appropriate materials and equipment that were in good working condition. Program uses tricycles and portable play structures that are set up and taken down daily. LPA observed play structures to have resilient padding. LPA did not observe any loose debris or hazardous materials in outdoor area.

Children are signed in and out of facility by parents' written signatures. At time of LPA's visit, all children were properly signed into program. Facility has license documentation and information properly posted and available for review. Emergency drills are conducted at least once every six months and are properly logged.

LPA reviewed facility records that included 10 children's records, staff records and parent/volunteer records. All facility records were observed to be complete. Children's files have a record of emergency identification information on file. Both director and co-teacher have valid CPR certificates that are current and will expire in 2023 or 2024. Staff also have proof of required immunizations. Parent/volunteer records have health screening documentation as well as proof of required immunizations.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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 tools, please send them by email 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.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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: 10/03/2022

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Director 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 a Child Care Center. 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

No deficiencies were issued under CCR, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with director, Johana Barahona.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

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