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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002534
Report Date: 08/19/2021
Date Signed: 08/19/2021 02:36:20 PM

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-MALCOLM X EES (PS)FACILITY NUMBER:
384002534
ADMINISTRATOR:ROSEN, ELENAFACILITY TYPE:
850
ADDRESS:350 HARBOR ROADTELEPHONE:
(415) 379-2700
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94124
CAPACITY:40CENSUS: 7DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Nicole VirgilioTIME COMPLETED:
12:55 PM
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On August 19, 2021 at 10:00 AM, Licensing Program Analysts (LPA) Sheran Lo granted entrance by Administrator Mindee and met with Lead Teacher Nicole Virgilio for an annual inspection. Purpose of the inspection was explained. Present, in the facility are 3 staff, and 7 children in care. Facility is operating within its capacity and is in compliance with staff / child ratio on this day. Facility operates day care from Monday - Friday 8:00am to 5:00pm.

With Lead Teacher, LPA inspected the day care rooms and play yard. Storage for children's belongings are in the classroom. LPA observed facility has smoke detector, carbon monoxide detector, fully charged fire extinguisher and working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Facility floor is in good repair and free of any hazards.

There are first aid supplies available in the classroom. All bathrooms are in working condition. All food is stored properly to avoid contamination. Facility has a sufficient amount of sleeping mats available. Individual Drinking Bottles and other items provided by the parents are labeled and stored appropriately. Food preparation area is free of litter. Food is stored adequately to prevent contamination. Facility uses the separate preschool courtyard for play. There is water available for children in the courtyard as well as in the classroom.

Report continues on next page……….

SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran LoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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 3
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-MALCOLM X EES (PS)
FACILITY NUMBER: 384002534
VISIT DATE: 08/19/2021
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Continuation from previous page .............

LPA observed that facility is using paper sign in / out. LPA collected a print-out of sign in/out. Facility has license and all other required documents posted and visible for the public. There are menus posted at least one week in advance and are visible to the child's authorized representative. Facility has an emergency drill log for the new school year. At 10:30 AM, LPA reviewed the facility records. LPA reviewed 4 random children's files. LPA reviewed 2 random staff's files.

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.

Administrator is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Incidental Medical Services (IMS) policy was discussed. 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
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran LoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SFUSD-MALCOLM X EES (PS)
FACILITY NUMBER: 384002534
VISIT DATE: 08/19/2021
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>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.

This report must be available in the facility for public review. Administrator was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov


Report was reviewed and signed by Administrator. Today’s report, August 19, 2021 and notice of site visit will be emailed to fitzsimonsm@sfusd.edu by close of business. Confirmation of receipt is required.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran LoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3