384002480-8-29-2022-05-CC-LGOZ-CHS2UM-20220829174235

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002480
Report Date: 08/29/2022
Date Signed: 08/29/2022 05:43:19 PM

Document Has Been Signed on 08/29/2022 05:43 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:	LANGUAGE IN ACTION-JOSE CORONADO CLUBHOUSE (PS)		FACILITY NUMBER:	384002480
ADMINISTRATOR:	AMORY DONOHUE, FOUNDER		FACILITY TYPE:	850
ADDRESS:	2498 FOLSOM STREET		TELEPHONE:	(415) 606-1205
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 22	TOTAL ENROLLED CHILDREN: 22	CENSUS: 7	DATE:	08/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Libby Flores		TIME COMPLETED:	05:50 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 8/29/2022 at 2:35PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Teacher, Leeby Flores. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Present were two staff supervising seven children. Children present had been properly signed in. Preschool program utilizes one classroom and outdoor play space. Day and hours of operation are Monday- Friday, 8:00AM- 5:00PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 2:40PM., LPA observed the following: Classroom was clean with age-appropriate playthings available for the children. Floors and ground surfaces were free of obstructions. Furniture, books and art supplies were in proper repair. Classroom was equipped with storage cubbies for children’s belongings and child sized table and chairs. Bathroom had adequate supplies for hand washing. Fixtures tested were operating condition. Staff bathroom is located separately. For napping services, foldable mats are stored in the closet. Per staff, napping sheets are washed weekly by families. Classroom had acceptable ventilation and lighting. Detergents; cleaning supplies; and toxins were stored inaccessible to children. LPA reminded facility to ensure all electrical outlets and trash bin are covered. Classroom have functioning smoke detector; carbon monoxide detector; and fully charged fire extinguisher; 3A:40BC. First aid kit was reviewed during inspection. At 3:00PM., LPA inspected the outdoor play area. Area was enclosed with tall fencing and an available shaded rest area. Outdoor space was observed free of debris or hazardous plants or objects. Play structure is in good repair and anchored. Soft rubber cushioning had been installed around structure for added safety. Per teacher, for water services refillable water bottle are brought outside by staff. LPA reminded facility to ensure all children water containers are labeled with child’s name. (REFER TO 809C FOR CONT.)

Cindy Interiano
Luis Gomez
	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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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Document Has Been Signed on 08/29/2022 05:43 PM - It Cannot Be Edited

Created By: Luis Gomez On 08/29/2022 at 04:09 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LANGUAGE IN ACTION-JOSE CORONADO CLUBHOUSE (PS)	FACILITY NUMBER: 384002480
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on record review and interview, LPA confirmed staff’s required mandated reporter training certification (AB1207) had expired.
	POC Due Date: 09/16/2022
	Plan of Correction
1 2 3 4	Facility will ensure staff (S1, S2) updated the mandated reporter training certification (AB1207) by the due date: 9/16/2022. Proof of correction will be submitted 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

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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: LANGUAGE IN ACTION-JOSE CORONADO CLUBHOUSE (PS)	FACILITY NUMBER: 384002480
	VISIT DATE: 08/29/2022

NARRATIVE

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(Page 2)
At 3:15PM, LPA review facility records including seven children’s files and two personnel files. Staff files reviewed and included Notice of Employee Rights (LIC9052); Proof of Required Immunization; Criminal Record Statement; and Declaration to Report Suspected Child Abuse (LIC9108). LPA reminded facility to ensure staff’s proof of education is stored in the facility files.

At 3:30PM., Based on record review and interview, LPA confirmed staff’s required mandated reporter training certification (AB1207) had expired.

Present staff member’s CPR/ 1^st aid certification was current, expiring on 05/2023.
Disaster drills are conducted every six months with the last drill done on 8/22/2022, properly logged.

Children’s files included the: Consent for Medical Treatment (LIC627), Immunization Record, Identification of Emergency Information (LIC700), Health History, Personal Rights (LIC613A) and Notification of Parent’s Rights (LIC995).

LPA observed required postings including: License, Child Passenger Safety Laws Poster, Parents Rights (PUB393), Emergency Disaster Plan (LIC610). Per teacher, snacks and lunches are provided by families only. Children’s medication was reviewed during inspection.

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
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: LANGUAGE IN ACTION-JOSE CORONADO CLUBHOUSE (PS)	FACILITY NUMBER: 384002480
	VISIT DATE: 08/29/2022

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 an cited on 809D. Exit interview, plan of correction and report was reviewed with Teacher, Libby Flores and signature of this form acknowledges receipt of these documents.

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
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC809 (FAS) - (06/04)

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