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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002319
Report Date: 04/05/2024
Date Signed: 04/05/2024 03:22:53 PM


Document Has Been Signed on 04/05/2024 03:22 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 CC RO, 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:
04/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Setareh PooyanTIME COMPLETED:
03:35 PM
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On April 05, 2024, at approximately 8.50am (visit both preschool & infant/toddler licenses), Licensing Program Analyst (LPA) Tso met with Director Setareh Pooyan, for an unannounced required visit to the child care center listed above. LPA explained the reason for the inspection and was granted access to the facility. This is a combination Center with Infants / Toddler and Preschool programs operating in the same building with different licenses. Present there were 12 teachers supervising 24 children today. The facility staff-to-child ratios are met. Hours of operation are Monday- Friday, 7:00 am- 5:00 pm.

LPA assessed the Center for Health and Safety Hazards with the Director. Per Director, there are no changes to the existing physical plant. The facility maintains a record of sign-in/out for children. The children’s classroom environment appeared clean and organized, with appropriate heating, lighting, and ventilation. The Center also provided age-appropriate toys, furnishings, changing tables, and equipment. LPA did not observe any pools, spas, or other bodies of water at the facility. According to the Director, no firearms or weapons are present at the Center, and all cleaning materials and potentially hazardous objects are kept out of reach of children. Personnel restrooms are separate from children, and all solid waste storage containers have tightly fitted lids. The Center also maintains multiple carbon monoxide detectors, centralized smoke alarm, fully charged fire extinguisher, and First Aid kit. Designated cubbies are available for children to store their belongings. There is sufficient sleeping equipment and cots for each child, and all mats and bedding are kept in the appropriate location. LPA also observed that the food preparation site is clean, organized, and inaccessible to children.

Preschool program shares outdoor space with infant license. Director are aware preschool and infant children are not to use shared outdoor playgrounds at the same time. LPA observed outdoor space to have separated areas for each program. There is a chicken coop in outdoor area that is kept separate from children's play areas. LPA observed chicken coop to be properly maintained and cleaned. Water is made available to children indoors and outdoors with facility's water pitcher and/or children's individually labeled water bottles.
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man TsoTELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HOLY FAMILY DAY HOME INFANT/TODLR CTR.
FACILITY NUMBER: 384002319
VISIT DATE: 04/05/2024
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LPA checked the personnel and children's records at the facility. A sample of children's files was found to contain comprehensive information such as medical assessments, needs, services, feeding plans, and signed admission agreements. The staff files were also well-organized and thorough, with Mandated Reporter Training Certificate (AB1207) valid until 05/25 and respectively. Multiple staff members were observed to have valid CPR/First Aid cards and vaccine proofs for Measles, Pertussis, and Influenza in their files. Additionally, the facility had posted the required documents, including the license, menus, waivers, Notification of Parental Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. The Director stated that fire and earthquake drills are conducted monthly, with the most recent fire drill being held in March 2024.

LPA discussed the safe sleep regulations with the 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 the Director 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.

LPA reminded the Director that as of September 1, 2016. A person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles.

The Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) 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/.

The Director 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.
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man TsoTELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HOLY FAMILY DAY HOME INFANT/TODLR CTR.
FACILITY NUMBER: 384002319
VISIT DATE: 04/05/2024
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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.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. The result indicated by the laboratory report that leads in the drinking water levels were below the current California Action limit of 5.5ppb.

The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to be completed every two years by all staff hired a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

The Director 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.

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/process.

There were no deficiencies cited at this time under CCR, Title 22, Div. 12, Chapter 3. A copy of today’s report was given to the Director.
Notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Director, Setareh Pooyan.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Man TsoTELEPHONE: (650) 379-9021
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC809 (FAS) - (06/04)
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