384002319-8-6-2019-05-CC-LGOZ-BESSHC-20190806135319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002319
Report Date: 08/06/2019
Date Signed: 08/06/2019 01:53:27 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:	HOLY FAMILY DAY HOME INFANT/TODLR CTR.		FACILITY NUMBER:	384002319
ADMINISTRATOR:	MEYERS-THUM, KIM		FACILITY TYPE:	830
ADDRESS:	299 DOLORES ST.,RMS #1 & #2		TELEPHONE:	(415) 861-5361
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94103
CAPACITY:	31	CENSUS: 22	DATE:	08/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Director, Kim Meyers- Thum		TIME COMPLETED:	02:10 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) Luis J. Gomez met with director Kim Meyers- Thum. The purpose of the visit was explained and is for an annual inspection. This is a combination center, which operates an Infant/ Toddler preschool program. Present is the director and 10 staff supervising 22 children (11 toddler, 11 Infant). Program uses an electric sign-in and out system. LPA Gomez observed facility waiver is posted next to the front door. The Program operates year-round and uses 2 classroom; (Otter and Sea Lion) and 2 outdoor play areas for childcare. Hours of operation are: Monday- Friday 7:00am- 5:30pm. Facility was inspected indoors and outdoors for Health and Safety hazards. The classrooms are equipped with age appropriate toys, puzzles, blocks, books and equipment that are in good repair. Classrooms have acceptable ventilation and ample lighting. The infant classroom (Otters) has child safe gates to separate the room into different sections. For children who take naps, stackable cots and covers available in the corner. LPA Gomez observed classrooms are equipped with a smoke and carbon monoxide detectors and fire extinguishers (2A10BC). First Aid Kit and Emergency supplies are properly maintained and kept inaccessible to children next to the sink. All cleaning products and toxins are maintained inaccessible to children and locked in classroom cabinets. Emergency drills are done monthly, with the last drill conducted on 07/16/2019 properly logged in. Both classrooms are equipped with a children's bathroom. Each bathroom has a child size toilet and child size sink. The infant classroom (Otters) has 2 changing tables with a adult sinks within arms reach. LPA Gomez observed restrooms are maintained clean, in good repair, and with adequate supplies. Staff use a separate restroom located in the hallway. Programs utilize an 2 outdoor play areas for the children (Bikes and Little Yard). LPA Gomez inspected outdoor play area for safety hazards and dangerous conditions. LPA Gomez observed play area is equipped with a swing, small structures and bikes for the children to use. Entire outdoor and off-limit areas are separated and enclosed with fencing and a latched gate. Drinking water is readily available indoors and outdoors children with labelled children’s cups. Directed stated that the program provides daily meals and snacks for the children. All required licensing information is properly posted in the front next to the main door. Continue to page 2...

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019

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: HOLY FAMILY DAY HOME INFANT/TODLR CTR.	FACILITY NUMBER: 384002319
	VISIT DATE: 08/06/2019

NARRATIVE

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LPA Gomez reviewed Personnel Files, Facility Roster and Children’s Files during today's inspection. LPA Gomez observed Personnel Files, Children's files and Facility Roster were reviewed and are current and up-do-date. Staff’s CPR/ 1st aide certification is current, expiring 3/2020.

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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Site Director was reminded 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.

Site Director was informed about the Provider Information Notices (PINs) on CCLD website.

Site Director was reminded to make sure all staff have Mandated Reporter Training certificate on file.

>No deficiencies were issued today under Title 22 Division 12 of the Ca. Code of Regulations.

This report and a Notice of Site Visit are provided to .

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.
Site Supervisor was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019

LIC809 (FAS) - (06/04)

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