384002717-5-26-2023-05-CC-LGOZ-CS7UA8-20230526152420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002717
Report Date: 05/26/2023
Date Signed: 05/26/2023 03:24:45 PM

Document Has Been Signed on 05/26/2023 03:24 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SFUSD-PAUL REVERE EARLY EDUC SCHOOL		FACILITY NUMBER:	384002717
ADMINISTRATOR:	EATON, WILLIAM		FACILITY TYPE:	850
ADDRESS:	555 TOMPKINS ST.,RM 107 & 108		TELEPHONE:	(415) 695-5656
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	48	CENSUS: 16	DATE:	05/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Assistant Principal, Swaicha Chanduri		TIME COMPLETED:	03:35 PM

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On 5/26/2023 at 12:00PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Assistant Principal, Swaicha Chanduri. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate preschool-age program, at Paul Revere Elementary School. Present was the principal and 7 staff supervising 16 children. Children present had been properly signed in. Per assistant principal, preschool graduation is being held today on-site. Classroom personnel receive criminal record clearances though school district. Classroom Preschool program utilizes two classrooms: #107, #108 and an Outdoor Play Area. Day and hours of operation are Monday- Friday 9:30AM- 3:45PM; Classroom #108, operates 9:30AM-1:30PM. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 1:00PM., LPA observed the following: Classrooms were clean, orderly, with age-appropriate playthings available for the children. Floors/ ground surfaces were free of any obstructions or potential hazards. Classrooms were equipped with labeled cubbies and hangers for storage of children's belongings. Accessible furniture, art supplies, and books inspected were free of sharp corners or splinters. Classrooms have child- sized tables and chairs for seated activities. Children’s bathrooms, located in each class is maintained clean. Changing table is located classroom #108. Per teacher, area is disinfected after each use. Fixtures tested were in operating condition. Staff bathroom is located separate. For napping services, LPA observed stackable cots. Cots was made of cleanable material. Per principal, sheets and blankets are washed weekly. Classrooms had acceptable ventilation and lighting. Disinfectants, poisons, and cleaning compounds have been stored inaccessible to children. Outlets and trash bins have been covered. Classrooms have functioning carbon monoxide detector, smoke detector (built-in), telephone service, and fully charged fire extinguishers: 2A10BC. First aid kit was reviewed and is fully stocked.

LPA inspected the outdoor play area. Play area was completely enclosed with tall fencing. Shading resting area is available for children. LPA reminded assistant principal to ensure broken playthings are removed from outdoor play area. Broken tricycle was removed during inspection. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPA inspected kitchen/ food storage area. Kitchen area was clean and free of any trash or rubbish. Refrigerator is in correct use with temperatures checks logged.
(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-PAUL REVERE EARLY EDUC SCHOOL	FACILITY NUMBER: 384002717
	VISIT DATE: 05/26/2023

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(Page 2)
LPA reviewed facility records including six children’s files and two personnel files. Staff’s files contained the: Notice of Employee Rights (LIC9052); Education Verification; and Personnel Record (LIC501).

LPA reminded facility to ensure staff proof of required immunization are stored in facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

Children’s files contained the: Consent for Emergency Medical Treatment (LIC627); Identification and Emergency Information (LIC700); Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

Staff member had their ‘Cardiopulmonary Resuscitation and First Aid’ certification, which expires on: 3/2024.

Emergency disaster drill are conducted on-site, with the last drill completed on, 4/23/2023, and properly logged.

LPA observed required posting outside classrooms, including the: Facility License; Notification of Parent’s Rights (PUB394); Emergency Disaster Plan (LIC610); and California Child Passenger Safety Laws.

LPA reviewed children’s medication during inspection. ‘Incidental Medical Services’ (IMS) plans are stored in children’s files.

Incidental Medical Services (IMS) policy was discussed. 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

(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-PAUL REVERE EARLY EDUC SCHOOL	FACILITY NUMBER: 384002717
	VISIT DATE: 05/26/2023

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(Page 3)
Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility, unless he or she has been immunized for influenza, pertussis and measles or qualifies for an exemption pursuant to Health and Safety Code 1596.7995 and 1597.662.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations. Exit interview report was reviewed with Assistant Principal, Swaicha Chanduri and signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director 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: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC809 (FAS) - (06/04)

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