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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002503
Report Date: 05/09/2022
Date Signed: 05/09/2022 02:15:06 PM


Document Has Been Signed on 05/09/2022 02:15 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:SFUSD-GORDON J. LAU EES (PS)FACILITY NUMBER:
384002503
ADMINISTRATOR:CHOY, GLORIAFACILITY TYPE:
850
ADDRESS:950 CLAY ST.TELEPHONE:
(415) 291-7932
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94108
CAPACITY:24CENSUS: 16DATE:
05/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kimberly KuanTIME COMPLETED:
01:15 PM
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On May 9, 2022 at approximately 11:30am, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Required - 1 Year Visit at and met with Head Teacher Kimberly Kuan during the visit. Purpose of the inspection was explained. There are 16 children 2 staff members. Teacher to child ratios were met on this day. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The facility operates Monday, Tuesday, Thursday, Friday from 08:55AM to 2:55PM & Wednesday 8:40AM-1:40PM. The program uses clipboard for parents to sign their children in and out of the program. All children were signed into the system.

LPA inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Per the Site Director, there are no firearms or weapons in the center. Adequate first aid supplies are available. Medications are stored in locked cabinet inaccessible to children. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. Children meals are cater from outside vendor and being sent to the program everyday. Menus are posted in the classroom. All solid waste storage containers have tight fitting lids. Drinking water is provided indoor and outdoor by water bottles.

Facility has an outdoor play area. LPA toured the outdoor area call Basketball Court Playground for Health and Safety Hazards. LPA observed outdoor has shaded area and picnic table to allow children to rest. Last Emergency Drill was conducted on 04/19/2022 and properly logged.

At approximately 12:15pm, A random sample of ten children's and two staff’s files were reviewed and found to be complete. At least one staff have current Pediatric First Aid and CPR. Facility has posted all the required licensing forms in a prominent visible location.

CONTINUED>>>
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
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 2


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: SFUSD-GORDON J. LAU EES (PS)
FACILITY NUMBER: 384002503
VISIT DATE: 05/09/2022
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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. 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)/ (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

Facility was also 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.

LPA discussed Child Abuse Mandated Training AB1207 with the Head Teacher. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Head Teacher. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

Head Teacher was also advised to reach out to San Bruno Regional Office for concern or questions. Desk Duty is available M-F, 8a.m.-5p.m. (650) 266-8800. Website for forms and regulations updates: www.cdss.cs.gov/inforesources/Community-Care-Licensing

An Exit Interview was conducted with Head Teacher. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and appeal rights were discussed and will be emailed to Head Teacher whose signature on this form confirm receipt of these reports. Notice of Site Visit will also be emailed. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2