384002717-8-20-2024-05-CC-LGOZ-D8BVKN-20240820163038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002717
Report Date: 08/20/2024
Date Signed: 08/20/2024 04:31:00 PM

Document Has Been Signed on 08/20/2024 04:31 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 CC RO, 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: 8	DATE:	08/20/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	William Eaton		TIME COMPLETED:	04:35 PM

NARRATIVE

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On 8/20/2024 at 12:55PM., Licensing Program Analyst (LPA), Luis Gomez met with Principal, William Eaton. The purpose of today's visit was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate a preschool program. Present was the principal and four staff supervising 8 children. District personnel receive criminal record clearances through school district. The preschool program utilizes 2 classrooms: #107, #108 and the Outdoor Play Area. Per principal, Classroom #107 is not currently in operation. LPA inspected this facility for health and safety hazards.

At 1:05PM., LPA observed the following: Classroom was clean, neat, with age-appropriate materials available for the children. Floors and ground surfaces were clear of obstructions or hazards. Classroom was equipped with tables and chairs, scaled to the proper size, and labeled cubbies for children's belongings. LPA observed additional cabinets nears the sink, with safe locks installed. The children’s bathroom was observed clean with toilets and faucets in operating condition. Diaper changing table was available in bathroom for staff use. Per staff, padding and area is cleaned/disinfected by staff. For solid waste, trash bin with tight-fitting lid was available. Per staff, solid waste is removed from bin daily. The classroom had adequate ventilation; lighting; and was a comfortable temperature. Facility has a functioning telephone service and fire extinguisher: 3A:80:BC. First aid kit was reviewed during inspection.

LPA reminded facility to ensure carbon monoxide detector is in proper working order. Advisory Note: Technical Violation (LIC9102TV) was issued.

Cleaning compounds, detergents, medications, and other items which could pose a danger, had been stored inaccessible to children. (REFER TO 809c, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-PAUL REVERE EARLY EDUC SCHOOL	FACILITY NUMBER: 384002717
	VISIT DATE: 08/20/2024

NARRATIVE

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(Page 2)
At 1:30PM., LPA inspected outdoor play area. Outdoor play area was completely enclosed with tall fencing. Absorbent rubber padded squares had been installed, underneath and around play structure. Shaded rest area was made available for children. Per staff, water services are available with use of refillable bottles and fountains.

At 1:32PM., Based on observation, LPA confirmed broken tricycle and wheel barrel in the outdoor area. Items were removed during inspection. Advisory Note: Technical Violation (LIC9102TV) was issued.

Food preparation/ kitchen was reviewed during inspection. Area was observed clean, free of litter or rubbish. Food items inspected were current.

LPA reviewed facility records including five children’s files and personnel files.
Staff’s files reviewed contained the: Education Verification; Proof of immunization; and Personnel Record (LIC501).

LPA reminded facility to ensure all staff files are available for Department review.

The 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: 10/2024.

Emergency disaster drills are done site-wide, with the last drill completed on, 5/30/2024, and properly logged.

LPA observed required postings including the: Facility License; Notification of Parent’s Rights (PUB394); Personal Rights (LIC613A); Passenger Safety Laws (PUB269); and Emergency Disaster Plan (LIC610). (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SFUSD-PAUL REVERE EARLY EDUC SCHOOL	FACILITY NUMBER: 384002717
	VISIT DATE: 08/20/2024

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(PAGE 3)
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

Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed child care centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN21-21- CCP.

Facility 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 Principal, William Eaton 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. Principal was advised any additional questions to call office, M-F, 8:00AM- 5:00PM, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC809 (FAS) - (06/04)

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