384002350-2-8-2022-05-CC-CQUO-CBFTSG-20220208135906

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002350
Report Date: 02/08/2022
Date Signed: 02/08/2022 01:59:51 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:	UCSF KIRKHAM CDC (PS)		FACILITY NUMBER:	384002350
ADMINISTRATOR:	NANCY TRINH COSTANTIELLO		FACILITY TYPE:	850
ADDRESS:	10 KIRKHAM STREET		TELEPHONE:	(415) 664-1217
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94143
CAPACITY:	93	CENSUS: 67	DATE:	02/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Nancy Trinh Costantiello & Connie Lui		TIME COMPLETED:	02:15 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 February 8, 2022 at 10:25am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual, required inspection. LPA met with center director, Nancy Trinh Costantiello, and health and safety director, Connie Lui, and explained the purpose of the inspection. Hours of operation are Monday to Friday 7:00am to 6:00pm. Present during inspection included center director, health and safety director, 12 teachers, and 67 enrolled children (all preschool age). Facility is currently operating within teacher to child ratio on this date. With center director, LPA inspected entire facility for health and safety hazards. Facility is a multi-level facility that includes 6 classrooms. Currently, program is being operated in 4 of the 6 classrooms. 2 classrooms operate on the upper level of the facility while another 2 classroom operate on the lower level of the facility. LPA observed each classroom to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located inside the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system throughout the building as well as multiple fully charged, fire extinguishers. Each classroom has a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information. Medication is stored appropriately, inaccessible to enrolled children and maintained with proper documentation. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility's high shelves. Facility currently provides a food service. LPA observed a shared kitchen between classrooms on both upper and lower level of facility. Kitchen and food prep areas were observed to be clean, neat and orderly. All food is stored and prepared properly to avoid contamination. Water is available to children indoors and outdoors with children's water bottles, labeled with child's individual names. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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: UCSF KIRKHAM CDC (PS)	FACILITY NUMBER: 384002350
	VISIT DATE: 02/08/2022

NARRATIVE

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Outdoor area includes an upper and lower level, separating the different classrooms when utilizing the space. LPA observed facility maintains outdoor waiver. There are a variety of outdoor equipment that are in good working condition. Play structures have resilient padding. Children are signed in and out of facility by parents' electronic signatures. Facility has license documentation and information properly posted and available for review.

LPA reviewed facility records that included 10 children's records, 15 staff records (whom were present during inspection). LPA observed children's and staff's records to be complete. Multiple teachers have valid CPR certificates. Health and Safety director's CPR is current and will expire 08/2023. Last emergency drill was conducted 01/28/2022. Emergency drills are conducted at least once every month and are properly logged and documented.

Facility was 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.

Directors are 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 certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Directors were 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.

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.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: UCSF KIRKHAM CDC (PS)	FACILITY NUMBER: 384002350
	VISIT DATE: 02/08/2022

NARRATIVE

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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 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.

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

No deficiencies were issued under CCR, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with center director, Nancy Trinh Costantiello, and health and safety director, Connie Lui.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC809 (FAS) - (06/04)

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