384002732-8-19-2021-05-CC-JSAI-C62QHY-20210819121156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002732
Report Date: 08/19/2021
Date Signed: 08/19/2021 12:12:22 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:	CCFC - CLEO WALLACE CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	384002732
ADMINISTRATOR:	DAVIS, VERNEE		FACILITY TYPE:	850
ADDRESS:	71 TURNER TERRACE		TELEPHONE:	(415) 921-7019
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94107
CAPACITY:	35	CENSUS: 8	DATE:	08/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Site Supervisor Ericka Cruz		TIME COMPLETED:	12:20 PM

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Licensing Program Analysts (LPA) Jyoti Saini met with Site Supervisor Erica Cruz for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility. In addition to the Site Supervisor, there are 8 children and 4 staff present today. The facility operates Monday - Friday from 8:00 AM to 5:00 PM. The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed;

There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit is available in the facility. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition with sufficient cushioning underneath. The bathrooms appear to be safe, sanitary, and free of any hazardous items. There is drinking water readily available for children.The facility provides all napping supplies. The program provides daily snacks and lunch.The classroom has appropriate postings. The last Emergency Drill was conducted on 08/11/2021 and is properly logged.

The facility has a waiver to use an electronic record keeping system, however the facility is not currently using it. Parents manually sign in and out. LPA reviewed sign-in and out sheet. The center has a complete record of sign-in/out sheets by an authorized pick up person. The room has multiple working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available.

LPA reviewed storage of medications, equipment and supplies, and reviewed children, personnel and administrative records. All children have a record of emergency identification information on file.The Staff has a current Pediatric First Aid/CPR certificate on file. All staff has taken Mandated Reporter training.

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SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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: CCFC - CLEO WALLACE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 384002732
	VISIT DATE: 08/19/2021

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During inspection,

• Site Director was provided information regarding Incidental Medical Services (IMS). For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 101226. When any IMS is provided, a plan for providing IMS must be submitted to the Department.

• Site 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.

• Site Director was reminded about Mandated Reporter Training available on the CCLD website. Training must be completed every two years. (Websites: www.ccld.ca.gov or www.mandatedreporterca.com)

• Site Director was reminded about the Provider Information Notices (PINs) on the CCLD website.

No deficiencies were cited today.

This report was reviewed and discussed with Site Supervisor Erica Cruz and will be sent to the site supervisor at the email address ecruz@crossculturalsf.org by the close of business on 08/19/2021. Confirmation of receipt is required. This report will be kept in the facility file and will be made available for public review upon request.

Any additional questions, call CCLD Office, Monday - Friday, 8am - 5pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC809 (FAS) - (06/04)

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