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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002131
Report Date: 06/27/2022
Date Signed: 06/27/2022 01:09:39 PM


Document Has Been Signed on 06/27/2022 01:09 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:PRESIDIO KNOLLS SCHOOLFACILITY NUMBER:
384002131
ADMINISTRATOR:CHONGO, GABRIELA S.FACILITY TYPE:
850
ADDRESS:250 10TH STREETTELEPHONE:
(415) 202-0770
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:180CENSUS: 38DATE:
06/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gretchen StanersonTIME COMPLETED:
01:25 PM
NARRATIVE
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On June 27, 2022 at 9:00 AM, Licensing Program Analyst (LPA) Cowan met with Summer Program Director for a 1 Year Required Inspection. Purpose of the inspection was explained. Present, in the facility are director, 8 staff, and 38 children in care. Facility is operating within its capacity, and facility is in compliance with staff / child ratio on this day. Facility operates the Summer Day Care Program Monday to Friday from 8:00 AM to 5:30 PM. For the summer, the facility is operating from rooms 123, 3 and 7.

With director, LPA inspected the day care rooms and play yard. LPA observed facility has installed smoke and carbon monoxide detector, fully charged fire extinguisher, and working telephone on site. All cleaning solutions, poisons and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Facility floor is in good repair and free of any hazards.

There are first aid supplies available in the classroom. All bathrooms are in working condition. All storage containers for solid waste fitted lids. Facility has a sufficient amount of sleeping cots available. Sleeping cots are sanitized daily. Play yard is free of hazards. There is a sufficient amount of sand and poured rubber to help absorb the impact of falls. There is water available on the yard as well as in the classroom.
Report continues on next page……….
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022
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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Document Has Been Signed on 06/27/2022 01:09 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: PRESIDIO KNOLLS SCHOOL
FACILITY NUMBER: 384002131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 2 ou tof 9 staff members did not have Measles vaccine of file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2022
Plan of Correction
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Director agrees to collexct and email Measles vaccines for Ting Ho and Ting Ting Jim to LPA by 7-11-22.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 8 out of 9 staff members did not have a currwent Mandated Reporter Training Certificate of file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2022
Plan of Correction
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Director agrees to collect staff Mandated Reporter Certificates and email to LPA by 7-11-22.

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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022
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: PRESIDIO KNOLLS SCHOOL
FACILITY NUMBER: 384002131
VISIT DATE: 06/27/2022
NARRATIVE
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LPA observed that facility is using electronic sign in / out. LPA collected a print-out of sign in/out. Facility has license and all other required documents posted and visible for the public. Facility’s last emergency drill was conducted March 30, 2022, and is properly logged. At 10:57 AM, LPA reviewed the facility records. LPA reviewed 10 random children's files. Children’s files are complete with all required Licensing documents. LPA reviewed 9 random staff's files. At 11:04, LPA observed that staff member did not have Mandated Reporter Training Certificate of file. At 11:30 AM, LPA observed that staff member did not have Measles Vaccine on file. This is a potential risk to children in care and Type B citations are issued this day.

LPA discussed Keeping sand clean with director. Facility is using a automated motion sensor system to keep rodents and animals out of sand. Director states that the system is working pretty well. LPA discussed the keeping of facility files with director.

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

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.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
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: PRESIDIO KNOLLS SCHOOL
FACILITY NUMBER: 384002131
VISIT DATE: 06/27/2022
NARRATIVE
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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 certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

>See next page for deficiencies


Exit interview conducted and report was reviewed with the director Gretchen Stanerson.

This report must be available in the facility for public review. Notice of site visit is to be posted and shall remain posted for next 30 days. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

Copy of this report was reviewed and will be emailed to the director, Gretchen Stanerson and Simona Chongo at gretchen.stanerson@presidioknolls.org and SIMONA@PRESIDIOKNOLLS.ORG respectively by the close of business on 6/27/22. Confirmation of receipt is required. Signed copy of this report will be stored in the facility file.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
LIC809 (FAS) - (06/04)
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