384002445-9-12-2022-05-CC-LGOZ-CJ7R48-20220912124108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002445
Report Date: 09/12/2022
Date Signed: 09/12/2022 12:42:20 PM

Document Has Been Signed on 09/12/2022 12:42 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	GAN NOE PRESCHOOL		FACILITY NUMBER:	384002445
ADMINISTRATOR:	POTASH, LEAH		FACILITY TYPE:	850
ADDRESS:	3781 CESAR CHAVEZ STREET		TELEPHONE:	(415) 648-8000
CITY:	SAN FRNCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	30	CENSUS: 17	DATE:	09/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Leah Potash		TIME COMPLETED:	12:50 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 9/12/2022 at 8:40AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Leah Potash. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Present was the director and four staff supervising 17 children. All staff have their criminal record clearances on file. Preschool program utilizes two classrooms: Upper and Lower Classrooms and one (shared) outdoor play yard. Day and hours of operation are Monday- Friday , 8:30AM- 5:00PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 9:00AM., LPA observed the following: Classrooms were clean with age-appropriate playthings available for the children. Floors and ground surfaces were free of obstructions. Accessible furniture, books and materials inspected were in proper repair. Child safety gates have been installed blocking the off-limit areas. Classrooms were equipped with cubbies and several child sized table and chairs. Bathrooms and sinks had adequate supplies for hand washing. Fixtures tested were operating condition. Staff bathroom is located separate. For napping services, stackable cots are stored in each classroom. Per director, napping sheets are washed weekly by families. Classroom had acceptable ventilation and lighting. At 9:20AM., Based on interviews and observations, LPA confirmed bottles of alcohol stored in an unlocked cabinet. Cabinet was locked by director during inspection. Electrical outlets had been covered. LPA reminded licensee to ensure trash bins have proper coverings. Classrooms had functioning smoke/ carbon monoxide detector combo (built-in); and two (fully charged) fire extinguishers; 2A:40BC. At 9:40AM., LPA inspected the outdoor play area. Area is enclosed with tall fencing with accessible shading. Outdoor spaces were observed free of debris or hazardous plants or objects. LPA reminded director to ensure all broken playthings are removed from outdoor area. Rubber cushioning had been installed for added safety. Per director, water services are provided to children with use of refillable water bottles brought outside by staff. LPA reminded facility to ensure all children water bottles are labeled with child’s name. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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 5

Document Has Been Signed on 09/12/2022 12:42 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GAN NOE PRESCHOOL	FACILITY NUMBER: 384002445
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interviews and observations, LPA confirmed bottles of alcohol stored in an unlocked cabinet. This poses an immediate health and safety risk to children in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	Licensee will immediately remove bottles of alcohol from the day-care area. All registered families will sign the ,LIC9224, by the due date: 09/19/2022. Proof of correction will be submitted to the Department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: GAN NOE PRESCHOOL	FACILITY NUMBER: 384002445
	VISIT DATE: 09/12/2022

NARRATIVE

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At 10:10AM., LPA review facility records including nine children’s files and five personnel files. Staff files reviewed and included Notice of Employee Rights (LIC9052) and Declaration to Report Suspected Child Abuse (LIC9108).

At 10:35AM., Based on record review, LPA confirmed staff's proof of immunization missing from the facility files. During inspection Advisory Note: Technical Assistance (LIC9102TA) was issued.

LPA reminded director to ensure staff’s Mandated Reporter Training Certifications (AB1207) are stored in the facility files.

Present staff member CPR/ 1^st aid certification was current, expiring on 08/2024.
Disaster drills are conducted every six months with the last drill done on, 06/20/2022, properly logged.

Children’s files included the: Immunization Record; Identification of Emergency Information (LIC700); Health History; Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

LPA reminded director to ensure children immunization are stored in facility files.

LPA observed required postings including: Childcare License; Outdoor Space Waiver; Child Passenger Safety Laws; Notification of Parent’s Rights (PUB393); and Emergency Disaster Plan (LIC610).

LPA reminded licensee to post an updated snack menu for families.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm (REFER TO 809C FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: GAN NOE PRESCHOOL	FACILITY NUMBER: 384002445
	VISIT DATE: 09/12/2022

NARRATIVE

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

Type “A” violation was issued today. Licensee was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

This report and appeal right and rights were discussed. This report must be available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Any additional questions facility was advised to call Regional Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

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