384002203-12-17-2019-05-CC-MROZ-BJY2AP-20191217161352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002203
Report Date: 12/17/2019
Date Signed: 12/17/2019 04:14:00 PM

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:	SLIPPERY FISH INITIATIVE, INC.- PRESCHOOL		FACILITY NUMBER:	384002203
ADMINISTRATOR:	KNUTSON, MARIELLA		FACILITY TYPE:	850
ADDRESS:	999 BROTHERHOOD WAY		TELEPHONE:	(415) 585-5300
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY:	40	CENSUS: 18	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Sara Mathison O'Neill		TIME COMPLETED:	04:30 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	Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced Annual Random inspection. LPA met with Director Sara (Mathison) O'Neill and explained purpose of inspection. Center is a combination co-op program for infant and preschool. Preschool program resides in Rooms 4 and 5 with hours of operation Monday to Friday from 9:00am to 1:00pm. Room 2 and 3 are also available for preschool use on Mondays, Wednesdays, and Fridays from 9:00am to 1:00pm. Present in classroom was the Program Director, 2 Master Teachers, 1 ADA therapist, 6 parent volunteers, and 18 children. Center is operating within capacity requirements and in compliance with child to staff ratio. LPA toured and inspected Rooms 4 and 5 with Director. There are no bodies of water, firearms, or weapons on the premises. Classroom is in good condition with proper temperature and ventilation and is free of any hazards. Furniture in classroom is in good repair. Classroom has age appropriate toys and equipment. There is a fish tank for children's observation. The tank is covered and inaccessible to children. There is one bathroom outside of the classroom with three sinks, two toilets, and two urinals. There is an additional sink in the classroom and an outdoor sink in front of the bathroom for staff and children's use. Bathroom appears to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises. The outdoor play area is fenced for supervision with age appropriate toys and equipment in good condition with sufficient cushioning underneath. All required postings are posted on the door of the classroom. Center provides lunch and a snack in collaboration with parents. A menu is posted for the month online. Kitchen is clean and free of any toxins or contamination. Drinking water is available for children indoor and outdoors. All storage containers for solid waste have a proper lid. All cleaning products, chemicals, and toxins are inaccessible to children. Incidental Medical Services (IMS) was discussed. There is an IMS plan in place but there are no children receiving services during the school year. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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 2

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: SLIPPERY FISH INITIATIVE, INC.- PRESCHOOL	FACILITY NUMBER: 384002203
	VISIT DATE: 12/17/2019

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 from first page)

Last emergency drill was conducted in December 3 and 4, 2019. Emergency drills are conducted every six months and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person electronically. There is a working fire alarm system, a fully charged fire extinguisher, a smoke and carbon monoxide detector, and a working telephone available on site. Phone number listed is current.

Six children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff have a criminal record clearance on file. Staff have current Pediatric First Aid/CPR certificates expiring April 2021 and Mandated Reporter training certificates on file.

During inspection,
· Director was given information regarding Lead Poisoning Facts and Technical Support Program.
· Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
· Director was reminded about Mandated Reporter Training. Training must be completed by staff every two years. (Website: www.mandatedreporterca.com).
· Director was reminded about the Provider Information Notices (PINs) on CCLD website.

No deficiencies cited today.

This report was reviewed and discussed with Director Sara O'Neill. A copy of report was provided. Notice of site visit was observed being posted and shall remain posted for 30 days.

For any additional questions, call San Bruno CCLD Office, Monday - Friday, 8am - 5pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

The following forms are to be updated and submitted to CCLD by January 6, 2020:
LIC 308 – Designation of Administrative Responsibility
LIC 500 – Personnel Report
LIC 610 - Emergency Disaster Plan

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2