384002096-10-11-2023-05-CC-CQUO-CWHRTY-20231011131906

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002096
Report Date: 10/11/2023
Date Signed: 10/11/2023 01:19:12 PM

Document Has Been Signed on 10/11/2023 01:19 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
SAN BRUNO CC RO, 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: 20	DATE:	10/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Johana Barahona		TIME COMPLETED:	01:30 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 11, 2023 at approximately 10:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with director, Johana Barahona, and explained the purpose of the visit. Facility is a co-op program that operates part time from Monday to Friday 9:00am to 12:30pm with SFUSD calendar school year. Facility operates in Glenn Canyon Park in clubhouse. Present during LPA's visit included director, teacher, 5 parent volunteers, and 20 preschool children. Program is operating within capacity limits and ratio during LPA's visit. LPA inspected day care areas for health and safety hazards. LPA observed facility to have a variety of toys, equipment and furniture that were in good condition and age appropriate. There is a play structure inside the classroom with resilient padding underneath. There is also a loft inside the classroom that was observed to be safe. Classroom rules for the indoor classroom loft were properly posted. LPA observed there to be additional padding for additional safety. Classroom flooring includes carpeting that was observed to be clean, free of any stains or debris. Storage for children's belongings is located inside the classroom, labeled with children's individual names and photos. Classroom is appropriately ventilated with proper temperature. Classroom is equipped with a fire alarm, smoke detectors, carbon monoxide detector and first aid cabinet. LPA tested carbon monoxide detector in facility, which was observed to be working. LPA observed poisons, chemicals, and cleaning solutions to be inaccessible to children, stored in high shelves. Due to facility being a co-op, food service is provided by enrolled children's parents and/or authorized representatives. Food service is prepared in classroom kitchen and is distributed to children. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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

FACILITY NAME: NOE VALLEY NURSERY SCHOOL	FACILITY NUMBER: 384002096
	VISIT DATE: 10/11/2023

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
26
27
28
29
30
31
32

(Continued, Page 2...)
Children have access to water, indoors and outdoors, with children's individual water bottles. Water bottles can be refilled on site if needed from kitchen sink through a filtered water pitcher.

Classroom includes a bathroom that is shared with public park. During hours of operation, bathroom is exclusively utilized for children's use. LPA observed bathroom to be in proper working condition, equipped with appropriate sanitation products.

Outdoor area is entirely fenced and enclosed. Outdoor area is equipped with a variety of children's toys and materials that were in good condition. Storage for children's outdoor materials is properly locked. There is an additional play structure that has resilient padding underneath. Per director, play structure is laid out and put away daily. LPA did not observe any pools, spas or bodies of water on site.

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 referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Children are signed into and out of program by children's authorized representatives' written signatures. LPA observed licensing documentation to be properly posted and available for review in the classroom.

LPA reviewed facility records that included 5 random children's files and 2 teaching staff members' files, which were complete. Children's files have record of emergency identification information on file. LPA observed children's files to also include parent volunteers' required immunizations. Both director and teacher have a current CPR/First Aid certification.

Director 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.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 10/11/2023

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
26
27
28
29
30
31
32

(Continued, Page 3...)
Director 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.

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

LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication, equipment/supplies, and reviewed children’s, personnel, and
administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/

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.

Facility was cited a Type B citation for not completing lead testing requirements by due date. Appeal Rights were provided. A POC was discussed.

A notice of site visit was given and must remain posted for 30 days.

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

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 10/11/2023 01:19 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/13/2023
	Plan of Correction
1 2 3 4	Program has to schedule to test water fixtures used for water consumption and food preparation for lead levels. Completed LIC9275, LIC9276, LIC999 and results of lead levels to be submitted to LPA no later than POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4