384002453-2-7-2023-05-CC-CQUO-CNTSSU-20230207130830

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002453
Report Date: 02/07/2023
Date Signed: 02/07/2023 01:09:07 PM

Document Has Been Signed on 02/07/2023 01:09 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SFUSD-ROOFTOP EARLY EDUCATION SCHOOL (PS)		FACILITY NUMBER:	384002453
ADMINISTRATOR:	BURGOS, JEFFREY T.		FACILITY TYPE:	850
ADDRESS:	443 BURNETT STREET, ROOM 7		TELEPHONE:	(415) 379-2700
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY:	22	CENSUS: 12	DATE:	02/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Samantha Ferber		TIME COMPLETED:	01:30 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 7, 2023 at approximately 11:10am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. Program operates at SFUSD-Rooftop Elementary School in Room #7 only. LPA met with lead teacher, Samantha Ferber, and explained the purpose of the inspection. Present during LPA's visit included lead teacher, para educator and 12 enrolled children (all preschool age). Program is operating within capacity limits and ratio during LPA's visit. All individuals working at facility are fingerprint cleared through SFUSD. Preschool program operates Monday through Friday from 9:30am to 3:45pm. Wednesdays 9:30am to 2:30pm. LPA inspected the preschool classroom and outdoor area for health and safety hazards. LPA observed all licensing documentation and information is posted in the front entrance of preschool classroom. Classroom is equipped with a fully charged fire extinguisher, carbon monoxide detector, fully stocked first aid kit/ emergency backpack with emergency information. Classroom is also equipped with a fire alarm system and working phone on site that is implemented by school district LPA observed cleaning solutions, poisons and other chemicals to be stored inaccessible to children in classroom's high shelves. Classroom is equipped with age appropriate furniture and materials that were observed to be in good working condition. LPA observed accessible electrical outlets to be made inaccessible with child safety covers and/or blocked by furniture. There is sufficient space for children's belongings that is located in the classroom, labeled with children's individual names. Drinking water is made available with a filtered water station located in classroom. Classroom is also equipped with a sink that is accessible to children. LPA observed sink to be equipped with appropriate sanitation materials. (Continue on Page 2....)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-ROOFTOP EARLY EDUCATION SCHOOL (PS)	FACILITY NUMBER: 384002453
	VISIT DATE: 02/07/2023

NARRATIVE

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There is a separate bathroom in the classroom that is made for preschool program use only, that includes one toilet and one sink. Bathroom does not have a door and is in direct line of supervision of staff. LPA observed bathroom to be in proper working condition, equipped with appropriate toileting equipment and spare clothes if needed. Sink in bathroom and classroom do not produce water that is warmer than 120 degrees Fahrenheit.

Preschool program has a separate outdoor area from elementary school outdoor area. Preschool program has exclusive use over outdoor area that is fully fenced and enclosed. LPA did not observe any spas, pools or bodies of water on site. Outdoor area was observed to be equipped with appropriate toys and materials that were in good working condition. Outdoor area includes a play structure that has resilient padding underneath. Water is made available to children indoors and outdoors with filtered water station in classroom.

Preschool program uses paper sign/in out system. LPA observed children are signed in and out of program with parents' written signatures. At time of LPA's visit, all children were properly signed into program.

LPA reviewed five random children's, para educator and lead teacher's files. Children's and staff files were complete. Lead teacher's CPR and First Aid certificate is current and will expire 09/2023.

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.

Lead teacher 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.

Lead teacher was reminded that all staff hired are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-ROOFTOP EARLY EDUCATION SCHOOL (PS)	FACILITY NUMBER: 384002453
	VISIT DATE: 02/07/2023

NARRATIVE

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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.

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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Due to no ink in printer, LPA was unable to print report. LPA will email report to lead teacher. Acknowledgement of receipt of report is required.

Exit interview conducted and report was reviewed with lead teacher, Samantha Ferber.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

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