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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002303
Report Date: 07/08/2022
Date Signed: 07/08/2022 12:16:00 PM


Document Has Been Signed on 07/08/2022 12:16 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:FRIENDS OF POTRERO HILL NURSERY SCHOOLFACILITY NUMBER:
384002303
ADMINISTRATOR:LEICHT, MONICAFACILITY TYPE:
850
ADDRESS:1060-A TENNESSEE STREETTELEPHONE:
(415) 864-5464
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94107
CAPACITY:30CENSUS: 15DATE:
07/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Monica LeichtTIME COMPLETED:
12:15 PM
NARRATIVE
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On 7/8/2022, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the Friends of Potrero Hill Nursery School. LPA was granted entry by the director, Monica Leicht. LPA explained the purpose of the visit to the director. All facility’s staff members have had their criminal background checks cleared by Guardian. LPA observed the director, two teachers and one helper supervising fifteen children. From Monday to Friday, the hours of operation are 8:30 am. to 5:30pm.

LPA and the Director thoroughly checked the facility for potential health and safety hazards. Toys, furniture, and learning materials are all age appropriate in all classrooms. LPA observed that the outside furniture and play structures are in excellent condition. Wood chips and sand surround the outdoor play structures, absorbing any accidental falls. Resting mats are provided for children to use while napping. LPA observed that there were no bodies of water at the facility. All cleaning products, poisons, and other hazardous chemicals have been kept out of reach of children. The facility has smoke detectors, carbon monoxide detectors, fully charged fire extinguishers, centralized smoke alarms, and working phones. According to the director, there are no firearms or weapons in the facility.

LPA observed that the facility posted the required documents. (i.e., license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities).

LPA reviewed the records of ten children. All required forms were in the children’s file. The program uses a sign in / out sheet for authorized individuals to sign their children in and out. Children bring their own food to the facility.

LPA reviewed the records of four staff members. A review of staff records revealed that two of the staff members ***See Page 2 for continuation***

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2022
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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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: FRIENDS OF POTRERO HILL NURSERY SCHOOL
FACILITY NUMBER: 384002303
VISIT DATE: 07/08/2022
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Continued, Page 2 are currently certified in CPR and First Aid. A review of staff records also revealed that three staff members were missing their immunization records (MMR and TDAP), TB test, and transcripts. Following a final review, all staff members were found to have not completed their Mandated Reporter training. The facility received technical violations for missing immunization records, TB tests, transcripts, and Mandated Reporter training.

According to the Director, the Center simulates fire and earthquake drills every six months. The last fire and earthquake drill were conducted on 6/21/2022.

Licensee 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.



Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA encouraged the Director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

A copy of this report, and the “Notice of Site Visit” were given to the director.

A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with the director, Monica Leicht.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022
LIC809 (FAS) - (06/04)
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