384002662-11-14-2019-05-CC-LGOZ-BHWSJW-20191114125549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002662
Report Date: 11/14/2019
Date Signed: 11/14/2019 12:56:02 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:	CRAYON BOX PRESCHOOL, THE		FACILITY NUMBER:	384002662
ADMINISTRATOR:	RAZO, ADRIANA		FACILITY TYPE:	850
ADDRESS:	3215 CESAR CHAVEZ		TELEPHONE:	(415) 821-9008
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	83	CENSUS: 48	DATE:	11/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Director, Maria Sarmiento		TIME COMPLETED:	01:00 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

Licensing Program Analyst, Luis J. Gomez made an unannounced annual inspection. LPA met with Director, Maria Sarimento- Murilo and explained the purpose of inspection. The preschool program operates at St. Anthony’s Catholic Church. Program utilizes 5 classrooms: Classroom #1 (4-5 year old’s), Classroom #3 (4- 5 year old’s), Classroom #4 (3 year old’s), Classroom #8 (2 year old’s), Classroom #7 (4-5 years old’s), 3 multi-purpose rooms: Dance room, Dramatic play room, Room 6 an outdoor play yard. Hours of operation are Monday- Friday 8:00am- 6:00pm. The program operates all year with periodic breaks. Present is the director, administrator and 8 staff supervising 48 children. Facility is operating within capacity limits of the license on this day. LPA inspected facility with director for health and safety hazards.

At 9:00am on November 14, 2019 LPA inspected Classroom #1, Classroom #3, Classroom #4, Classroom #8, Classroom #7, Dance Room and Dramatic play room. LPA observed classrooms are clean, organized and have plenty of age appropriate toys, art supplies and books for the children. Each classroom has cubbies and several child size tables and chairs for activities. Classrooms equipped with a locked cabinet for storage. Napping mats are available for children and located in the hallway closet. Per director, blankets are taken home by the children and washed weekly. The facility has children’s bathrooms located in the classroom #1, dramatic play room and classroom #6. Restrooms are kept clean, in good repair, and maintained with adequate supplies. Staff use separate restroom located in the hallway. LPA observed all trash cans and outlets are properly covered. There has acceptable ventilation and natural lighting. Each classroom has a smoke detector, carbon monoxide detector and there are 2 fully charged fire extinguishers (3A40BC) located in the hallway. First aid kit and an emergency disaster supplies are available in the office.

(Continued on the second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

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 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: CRAYON BOX PRESCHOOL, THE	FACILITY NUMBER: 384002662
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/14/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/15/2019 Section Cited	1 2 3 4 5 6 7	101170(e)(2) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to criminal record review shall obtain a clearance or criminal record exemption. This requirement is not met as evidenced by.
	8 9 10 11 12 13 14	Based on a files review, LPA confirmed a facility staff member is not associated to the facility.This is potential health and safety risk to children care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

Page: 4 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: CRAYON BOX PRESCHOOL, THE	FACILITY NUMBER: 384002662
	VISIT DATE: 11/14/2019

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
26
27
28
29
30
31
32

Page 2...

At 9:45am on November 14, 2019 LPA inspected the facility Outdoor Play Yard and Room #6. LPA observed outdoor play yard is completely enclosed. Play yard has children’s play structure that is properly anchored and rubber padding squares for increase safety. Outdoor play area is kept clean and free of debris and hazardous items. Per director, children bring their own water bottles outside during play and facility uses refillable water container. Room #6 is used a a recreation room and has 2 sand tables and puzzles tables for the children.

Seven children and five personnel records were reviewed. All children files are complete. Staff CPR/ 1^st aid certification is current expiring: 09/2021. At 11:30am on November 14, 2019 Based on a file review, LPA observed a facility staff member not associated to the facility. Emergency drills are done monthly, with the last drill conducted on, 10/21/2019, properly logged. LPA Gomez observed required licensing information and waiver is properly posted in facility lobby.

Incidental Medical Services (IMS) was discussed. Licensee has no children who need services at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,

· Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· Director was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
· Director was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov

Continuation on page 3...

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

Page: 2 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: CRAYON BOX PRESCHOOL, THE	FACILITY NUMBER: 384002662
	VISIT DATE: 11/14/2019

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
26
27
28
29
30
31
32

Page 3...

Based on today's inspection, a deficiency was observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations and cited on the 809-D page. Director and LPA discussed a plan of correction and an exit interview was conducted with Maria Murillo, and her signature of this form acknowledges receipt of these documents.

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.
Site Supervisor was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4