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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002677
Report Date: 09/07/2021
Date Signed: 09/07/2021 01:11:59 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:TEACHING TOTS PRESCHOOL, INC.FACILITY NUMBER:
384002677
ADMINISTRATOR:ARSENIO, M. & ZHANG, X.FACILITY TYPE:
850
ADDRESS:939 IRVING STREETTELEPHONE:
(415) 731-9705
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY:30CENSUS: 14DATE:
09/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Melinda ArsenioTIME COMPLETED:
01:30 PM
NARRATIVE
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On September 07, 2021, at approximately 10:30AM, Licensing Program Analyst (LPA) Winnie Ly conducted an unannounced Case Management Visit and met with Site Director, Melinda Arsenio during the visit. Purpose of the inspection was explained. There were 3 staff including the Director caring for 14 children.

Today's visit is to inspect the facility due to a fire happened on 08/19/2021 at approximately 4-5pm. Per Director, fire happened in the unit on the second floor. At the time, facility had 4 children present with 2 staff. During today's visit, LPA Ly and Director toured the facility for health and safety hazard. LPA observed the ceiling is taped up and has signs of dampness.

During today's visit, the San Francisco Fire Department's Inspector also present at facility and have given clearance for facility to occupy the preschool areas.

The following deficiency Reporting Requirement was being cited observation in accordance with the California Code of Regulations, Title 22, see LIC 809D.

An exit interview was conducted and Plans of Corrections (POC) were developed and reviewed with Licensee. A copy of this report and appeal rights were discussed and left with Licensee whose signature on this form confirm receipt of these reports.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
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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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: TEACHING TOTS PRESCHOOL, INC.
FACILITY NUMBER: 384002677
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/07/2021
Section Cited

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102212 (a) (H) Reporting Requirement:
(a) Each licensee or applicant shall furnish to the Department reports as required by the Department including (H) Fires or explosions that occur in or on the premises. Based on information obtained....
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Facility's upstair unit was caught on Fire on 08/19/2021, facility fail to report incident to the department.
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Director must submit statement of understanding reporting requirement to the department by 09/21/2021.

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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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2021
LIC809 (FAS) - (06/04)
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