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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002319
Report Date: 05/10/2023
Date Signed: 05/10/2023 03:32:30 PM


Document Has Been Signed on 05/10/2023 03:32 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 FAMILY DAY HOME INFANT/TODLR CTR.FACILITY NUMBER:
384002319
ADMINISTRATOR:POOYAN, SETAREHFACILITY TYPE:
830
ADDRESS:299 DOLORES ST.,RMS #1 & #2TELEPHONE:
(415) 861-5361
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY:31CENSUS: 24DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:Setareh PooyanTIME COMPLETED:
02:15 PM
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On May 10, 2023 at 11:53 AM, Licensing Program Analyst (LPA) Cowan met with Site Director, Setareh Pooyan, for an unannounced annual random inspection. Present today is director, 8 staff, and 24 toddlers at this time. Facility is operating within its capacity, and facility is in compliance with staff / child ratio on this day. The center operates Monday - Friday 7:30 AM to 5:00 PM. The center is operating from two classrooms: Sea Lions and Baloogas.

At 12:06 PM, with site director, LPA inspected the toddler day care area for health and safety hazards today. LPA observed facility has working smoke detector, carbon monoxide detector, fully charged fire extinguisher, and working telephone on site. The center is clean, orderly, and in good repair. There are no pools, spas or other similar bodies of water on site. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. All furniture and equipment are clean and in good working condition. The center's furniture and equipment are age appropriate. There is a sufficient quantity of table/chairs and changing tables meet the capacity.

Parents provide bedding for mats. Bedding is sent home once a week for cleaning by parents while mats are wiped down and disinfected daily. Changing tables are within an arm’s reach of a sink. The center has a working carbon monoxide detector. LPA observed toddlers were supervised by staff in the classrooms and in the napping area. All solid waste storage containers have secure lids. The outdoor play area designated for the infants and toddlers was clean and in good repair. All toys and equipment are in working condition. Areas under high climbing equipment is adequately cushioned poured rubber.

At 1:28 PM, facility files were reviewed. All staff have criminal record clearances on file. Education units are on file for teaching staff. At least one staff member on site has current CPR/First Aid certification. Children's files were reviewed. Children's files are complete with all required Licensing documents.


Report Continues....
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HOLY FAMILY DAY HOME INFANT/TODLR CTR.
FACILITY NUMBER: 384002319
VISIT DATE: 05/10/2023
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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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Director 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.

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.

An exit interview conducted and report was reviewed with site director, Setareh Pooyan.

This report must be available in the facility for public review. Notice of site visit is to be posted for 30 days. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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