384002662-12-12-2022-05-CC-LGOZ-CM2SQV-20221212130523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002662
Report Date: 12/12/2022
Date Signed: 12/12/2022 01:05:46 PM

Document Has Been Signed on 12/12/2022 01:05 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:	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: 27	DATE:	12/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Maria Sarimento- Murillo		TIME COMPLETED:	01:15 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 12/12/2022 at 9:10AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Maria Sarimento- Murillo. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. This is a preschool program located St. Anthony’s Church. Present was the Director and four staff supervising 27 children. Staff present have criminal record clearances on file. Children present have been properly signed in by authorized representative. Preschool program utilizes three classrooms, Red, 4- 5 years olds; Green, 3 years old; Yellow, 2- 3 years olds, four multi-purpose area and one, shared, Outdoor Play Area. Day and hours of operation are Monday- Friday, 8:00AM- 5:30PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 9:20AM., LPA observed the following: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces leading to exits, were free of obstructions. Accessible furnishings, puzzles and materials inspected were in like-new condition. Each classroom was equipped with labeled cubbies for storage of children’s belongings. Classrooms have child sized tables and chairs for snack and seated activities. Children’s bathrooms, located in hallway, were clean with adequate supplies for hand washing. LPA reminded director to ensure all fixtures are in operating condition. For napping services, sleeping bags and mats are stored in each classroom and napping room. Per director, napping supplies are washed weekly by families. Facility was the proper temperature, with ventilation and lighting. Detergents; cleaning supplies/ compounds; and toxins are stored inaccessible to children. Electrical outlets and trash bins are covered. Classrooms had functioning smoke / carbon monoxide combination detector (Built-in); and one (fully charged) fire extinguishers; 2A:10BC. Facility’s first aid kit was reviewed. Food items and snack preparation area was reviewed. Food items inspected were current and properly stored. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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 5

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: 12/12/2022

NARRATIVE

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(Page 2)
At 9:55AM., LPA inspected facility’s outdoor play area. Outdoor area is completely enclosed with tall fencing. Area was free of debris or hazardous plants. Play structure is anchored and rubber padding has been installed for increased safety. Per director, water services are provided with use of refillable water pitchers and paper cups, brought outside by staff. LPA reminded facility to ensure all children food containers are labeled with child’s name.

At 10:20AM, LPA reviewed the facility records including seven children’s files and four personnel files. Staff files reviewed included the: Notice of Employee Rights (LIC9052); Criminal Record Statement (LIC508); Declaration to Report Suspected Child Abuse (LIC9102); and Proof of Teacher Qualification.

LPA reminded director to ensure staff's proof of required immunization and TB result/ risk assessments are stored in personnel files. Advisory Note: Technical Assistance (LIC9102TA) was issued.

At 10:30AM., Based on record review and interview, LPA confirmed staff's 'mandated reporter training certification' (AB1207) have expired. Advisory Note: Technical Assistance was issued.

Children’s files were reviewed and included the: Consent for Medical Treatment (LIC627); Identification of Emergency Information (LIC700); Health History (LIC702); and Notification of Parent’s Rights (LIC995); and Physician’s Report (LIC701).

Staff’s Cardiopulmonary Resuscitation / First Aid certification is current, expiring: 9/2023.
Emergency disaster drills are conducted on-site, with last drill done on, 8/31/2022, properly logged.

Required forms and posted, including the facility’s Childcare License; Child Passenger Safety Laws; Notification of Parent’s Rights (PUB394); Updated Snack Menu; Emergency Disaster Plan (LIC610).

LPA reminded licensee to post the outdoor space waiver in visible location.
(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: 12/12/2022

NARRATIVE

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(Page 3)
Director 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

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

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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview and report was reviewed with Director, Maria Sarimento- Murillo and signature of this form acknowledges receipt of these documents.

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	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC809 (FAS) - (06/04)

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