384002201-6-4-2024-05-CC-JTSE-D5WUP2-20240604154450

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002201
Report Date: 06/04/2024
Date Signed: 06/04/2024 03:45:11 PM

Document Has Been Signed on 06/04/2024 03:45 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:	FACESSF - MASONIC PRESCHOOL		FACILITY NUMBER:	384002201
ADMINISTRATOR:	MEI NA CHAN		FACILITY TYPE:	850
ADDRESS:	1101 MASONIC AVENUE		TELEPHONE:	(415) 355-0210
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94117
CAPACITY:	71	CENSUS: 36	DATE:	06/04/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Director, Mei Chan		TIME COMPLETED:	04:00 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 6/4/2024, at approximately 12:50PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Site Supervisor, Mei Chan (D1). LPA explained the purpose of the visit. Present during the visit was D1, 13 staff members, and 36 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility's operating hours are from 7:30AM to 5:30PM. LPA inspected the facility for any health or safety hazards. There are fully charged fire extinguishers that are at least size 2A10BC in each classroom. There is a fire alarm system running throughout the school. There is an operational carbon monoxide detector present in the facility. There are emergency exit routes posted in each classroom. Emergency exits are clearly marked and visible. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. The facility operates in Classrooms 1, 2, 3, and 4. LPA observed age-appropriate toys and learning materials to be present. There are cubbies available for each child in care. Children nap on cots that are provided by the facility. Blankets are brought from home and taken back once a week for washing. The facility provides bedding and cleans it on site. The facility provides breakfast, lunch, and snacks for children in care. Water is available in each classroom and provided from a non-contaminating source. The facility provides paper cups for children to drink from. Each classroom has one handwashing sink available for use. There are a total of eight toilets and seven sinks available for children to use in the facility bathrooms. LPA observed the outdoor play area to be free of debris and other loose articles. There are age-appropriate toys and equipment for children in care. There is a play structure present that is designated for use by children from the age of 2 to 12. There is resilient padding in the form of rubber mats. There are two sandboxes present. Per D1, teachers check the sandboxes every morning after the sandboxes are uncovered. Per the outdoor play waiver, there are only 26 children allowed to be outside at a time. LPA observed the facility to be in compliance with the waiver during the visit. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

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

FACILITY NAME: FACESSF - MASONIC PRESCHOOL	FACILITY NUMBER: 384002201
	VISIT DATE: 06/04/2024

NARRATIVE

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LPA inspected the gross motor room that is available for children to use. There is padding and age-appropriate equipment for children. There are two toilets and one sink for children to use. Water is accessible and there is a fully charged fire extinguisher present. The facility’s outdoor waiver allows for the use of the gross motor room by up to 10 children at a time. LPA observed the facility to be in compliance with the waiver during the visit.

LPA reviewed nine staff files, six children’s files, and facility records. There is at least one staff member present with current Pediatric First Aid/CPR. Staff qualifications are available for review. LPA advised that all staff members shall have current immunization records, Mandated Reporter Training, and health screening reports on file. LPA observed all children’s files to be complete. LPA observed all required postings to be posted and accessible for review in the main entrance of the facility. The last emergency drill was conducted on 4/17/2024. Emergency drills are properly logged and documented. The facility had tested its fixtures for lead and remediated all fixtures that had exceedances. The facility is in compliance with the Written Directives specified in CCP-21-21_1-CCP.

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.

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: FACESSF - MASONIC PRESCHOOL	FACILITY NUMBER: 384002201
	VISIT DATE: 06/04/2024

NARRATIVE

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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. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

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

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 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.

No deficiencies were cited during today's visit on 6/4/2024. See LIC9102-TA for technical assistance provided regarding immunization records, Mandated Reporter Training, and transferring clearances.

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

Exit interview conducted and report was reviewed with the facility representative, Mei Chan.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2024

LIC809 (FAS) - (06/04)

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