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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002445
Report Date: 01/19/2024
Date Signed: 01/19/2024 12:35:13 PM


Document Has Been Signed on 01/19/2024 12:35 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:GAN NOE PRESCHOOLFACILITY NUMBER:
384002445
ADMINISTRATOR:POTASH, LEAHFACILITY TYPE:
850
ADDRESS:3781 CESAR CHAVEZ STREETTELEPHONE:
(415) 648-8000
CITY:SAN FRNCISCOSTATE: CAZIP CODE:
94110
CAPACITY:30CENSUS: 22DATE:
01/19/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Leah Potash TIME COMPLETED:
12:40 PM
NARRATIVE
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On 1/19/2024 at 8:30AM., Licensing Program Analyst (LPA), Luis Gomez and Director/ Licensee, Leah Potash. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. This facility is licensed to operate a preschool program. Present during inspection was the Director and four staff supervising 22 children. The program utilizes two classrooms: Lower Classroom, Upper Classroom and the outdoor play area. LPA inspected facility for health and safety hazards.

At 8:40AM., LPA observed the following: Classrooms were clean with age-appropriate playthings available for the children. The floor and ground surfaces were clear of obstructions or hazards. Classrooms were equipped with cubbies for children's belongings, and children’s furniture was free of sharp corners or splinters. LPA observed has child- sized tables and chairs available for seated activities. Per director, lunch and snack services are served in the outdoor patio.

LPA reminded director to ensure all toxins and detergents are stored in a locked cabinet. Advisory Note: Technical Violation (LIC9108TV) was issued.

The children’s bathroom was maintained clean with fixtures in operating condition. Per Director, the staff bathroom is located separately. For napping services, LPA observed stackable cots, which were made from a cleanable material. Per director, napping sheets are washed weekly by authorized representatives. The facility has adequate ventilation and was a comfortable temperature. Classrooms had sufficient lighting. Facility has a testable smoke/ carbon monoxide detector, telephone service, and fire extinguishers: 2A:10:BC. LPA reviewed first aid kit during inspection. (REFER TO 809c, FOR CONT.)

SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024
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 7


Document Has Been Signed on 01/19/2024 12:35 PM - It Cannot Be Edited

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: GAN NOE PRESCHOOL
FACILITY NUMBER: 384002445

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 9:30AM., Based on interview, observations, and record review, LPA confirmed facility's fixtures, used for drinking water/ food preparation, have not been tested for lead contamination levels. This poses a potential health and safety risk to children in care.
POC Due Date: 02/05/2024
Plan of Correction
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Facility will ensure water fixtures are tested for lead contamination levels by the due date: 2/5/2024.
Proof of correction will be submitted to the Department via email.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:30AM., Based on record review, LPA confirmed staff missing "Mandated Reporter Training' (AB1207) certification missing from facility files. This poses a potential health and safety risk to children in care.
POC Due Date: 02/12/2024
Plan of Correction
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Director will ensure all staff have completed the required 'Mandated Reporter Training' (AB1207) by the due date: 2/12/2024. Proof of correction will be submitted to the Department via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 7


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: GAN NOE PRESCHOOL
FACILITY NUMBER: 384002445
VISIT DATE: 01/19/2024
NARRATIVE
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(Page 2)
At 9:05AM., LPA inspected the outdoor play yard. The outdoor yard was observed completely enclosed, with shaded rest available for the children. An absorbent material had installed on ground surface for added safety. Per director, water services are provided both inside and outside with refillable cups.

At 9:25AM., LPA reviewed facility records including: 4 children’s files and 5 personnel files.

At 9:30AM., Based on interview, observations, and record review, LPA confirmed facility's fixtures, used for drinking water/ food preparation, have not been tested for lead contamination levels.

Facility’s children’s files were reviewed, containing the: Immunization Records, Identification and Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Personal Rights (LIC613A) and ‘Written Medical Assessments’.

Facility’s staff’s files were reviewed and contained the: Teachers Qualifications, Notice of Employee Rights (LIC9052), and the Personnel Record.



LPA reminded director to ensure staff’s Health Screening Form and Proof of required Immunization are stored in the facility files. Advisory Note: Technical Violation (LICTV) was issued.

At 10:30AM., Based on record review, LPA confirmed staff missing 'Mandated Reporter Training' (AB1207) certification missing from facility files.

Facility personnel had their updated CPR/ 1st aid certification on file, expiring on 8/2024.
Site’s emergency disaster drills are conducted every six months, with last drill completed on 10/17/2023.

LPA observed required postings, posted in each classroom and included the: Facility License; Notification of Parent’s Rights (PUB394); Updated Snack/Lunch Menu; Passenger Safety Law (PUB269); and Emergency Disaster Plan (LIC610) (REFER TO 809c, FOR CONT.)

SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: GAN NOE PRESCHOOL
FACILITY NUMBER: 384002445
VISIT DATE: 01/19/2024
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(Page 3)
LPA referred licensee, Leah Potash to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

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

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication. (REFER TO 812c, FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: GAN NOE PRESCHOOL
FACILITY NUMBER: 384002445
VISIT DATE: 01/19/2024
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(Page 4)
During inspection, LPA and Director discussed annual fees due to the department. LPA provided online account access and current statement information to director.

Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations and cited on 809D. Exit interview, report, and plan of correction was discussed with Director/ Licensee, Leah Potash. Director’s signature on this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain 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.ccld.ca.gov
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC809 (FAS) - (06/04)
Page: 7 of 7