384002235-12-5-2023-05-CC-WLYY-CY92UM-20231205164234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002235
Report Date: 12/05/2023
Date Signed: 12/05/2023 04:42:47 PM

Document Has Been Signed on 12/05/2023 04:42 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	HOLY NAME PRESCHOOL		FACILITY NUMBER:	384002235
ADMINISTRATOR:	ALICE HO SEHER, DIR.		FACILITY TYPE:	850
ADDRESS:	1560 40TH AVENUE		TELEPHONE:	(415) 664-4753
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY: 75	TOTAL ENROLLED CHILDREN: 75	CENSUS: 48	DATE:	12/05/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Alice Ho Seher		TIME COMPLETED:	04:45 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 December 05, 2023 at approximately 1:00pm, Licensing Program Analyst (LPA) Ly conducted an Unannounced Annual Visit and met with Site Director, Alice Ho Seher during the visit. Purpose of the inspection was explained. There are 48 children 10 staff members including the Director present during the visit. Teacher to child ratios were met on this day. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The center uses a clip board for parents to sign their children in and out of the program. LPA and Site Director inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Adequate first aid supplies are available. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in locked box inaccessible to children. LPA reviewed medication procedures with staff. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. The center provides morning and afternoon snacks and has a vendor for children's lunch. Menus are posted in the center. All solid waste storage containers have tight fitting lids. Drinking water is provided indoor and outdoor with children's water bottles. LPA and Site Director also toured the outdoor play area for Health and Safety Hazards. LPA observed outdoor equipment is in good condition, free from loose, sharp or pointed parts. The play structure appears to be age appropriate for children in care. Areas under slides and other climbing equipment is adequately cushioned. Last Emergency Drill was conducted on 11/13/2023 and properly logged. During today's visit, a random sample of children's and staff’s files were reviewed and found to be complete. At least one staff have current Pediatric First Aid and CPR. Facility has posted all the required licensing forms in a prominent visible location. CONTINUED>>>...Page 2....

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOLY NAME PRESCHOOL	FACILITY NUMBER: 384002235
	VISIT DATE: 12/05/2023

NARRATIVE

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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.

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.

Facility have done lead test on January 27, 2020. Results showed facility has 2 outlets that have Lead Exceedance. Water outlet labeled as Site #3 is the preschool children's restroom. The other is the janitor's closet sink labeled as Site #5. Facility have put signs to notify users water outlets are for hand washing only. Lead exceedance poses a potential health, safety or personal rights risk to persons in care. Type B violation has been issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

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-care-centers/.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOLY NAME PRESCHOOL	FACILITY NUMBER: 384002235
	VISIT DATE: 12/05/2023

NARRATIVE

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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 also 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.

LPA discussed Child Abuse Mandated Training AB1207 with the Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

An exit interview was conducted and Plans of Corrections (POC) were developed and reviewed with Director. A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/05/2023 04:42 PM - It Cannot Be Edited

Created By: Winnie Ly On 12/05/2023 at 03:43 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOLY NAME PRESCHOOL	FACILITY NUMBER: 384002235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2023

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 record review, the facility conducted Lead Testing on January 27, 2020 which have 2 water outlets that have Lead Exceedance. Water outlet labelded as Site #3 is the preschool children's restroom. The other is the janitor's closet sink labeled as Site #5. Lead exceedance poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/05/2024
	Plan of Correction
1 2 3 4	1. Facility have already put up signs to notify users that outlets are only to be used for handwashing. 2. Facility needs to reach out to Tester to have result uploaded to the State Website.

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:

Garfield Leung

LICENSING EVALUATOR NAME:

Winnie Ly

LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

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