384002757-11-15-2019-05-CC-LGOZ-BHXVSX-20191115154215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002757
Report Date: 11/15/2019
Date Signed: 11/15/2019 03:42:27 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:	SF TIKES ACADEMY		FACILITY NUMBER:	384002757
ADMINISTRATOR:	SHIMKUNAS, SARAH		FACILITY TYPE:	850
ADDRESS:	1218 SOUTH VAN NESS AVENUE		TELEPHONE:	(415) 826-8222
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	117	CENSUS: 75	DATE:	11/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:37 PM
MET WITH:	Director, Sarah Shimkunas		TIME COMPLETED:	03:55 PM

NARRATIVE

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Licensing Program Analyst, Luis J. Gomez made an unannounced annual inspection. LPA met with Director, Sarah Shimkunas and explained the purpose of inspection. This is a preschool center with a Spanish program option. Programs utilizes 5 classrooms: Koala Classroom ( 2 year old’s), Elephant Classroom (2-3 year old’s), Grasshopper Classroom (3-4 year old’s), Fish Classroom (3 year old’s), Flamingo Classroom ( 3-4 year old’s), Art room, Multipurpose Room and 1 Outdoor Playground. The off limit areas are: Facility kitchen/ staff room. Hours of operation are Monday- Friday 8:00am- 6:00pm. The program operates year-a-round with periodic breaks. Present is director and 11 staff supervising 75 preschool children. Facility is operating within capacity limits of the license on this day. LPA inspected facility with director for health and safety hazards.

At 12:40pm on November 15, 2019 LPA inspected the Koala Classroom, Grasshopper Classroom, Elephant Classroom, Fish Classroom, Art Room and Facility Kitchen. LPA observed classrooms are clean, organized and have plenty of age appropriate toys, art supplies and games for the children. Facility cubbies available in the hallway and each classroom has several child size tables and chairs for activities. Stackable napping cots are available for the children and stored in the classrooms and hallways. Per director, blankets are taken home and washed weekly. Children’s bathrooms are located in each of the classroom. Children’s bathroom is kept clean, in good repair, and maintained with adequate supplies. Diaper changing tables are located in the koala, elephant and fish classrooms. Staff uses a separate restroom located in the hallway. LPA observed all trash cans are properly covered. Per director, Art Room is used for group activities. Facility Kitchen has a refrigerator or storage of children's food. All kitchen, food- preparation and storage areas are kept clean and free of litter and rubbish.

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SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

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: SF TIKES ACADEMY	FACILITY NUMBER: 384002757
	VISIT DATE: 11/15/2019

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(Page 3)

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. An exit interview was conducted with Sarah Shimkunas, and her signature of this form acknowledges receipt of these documents.

>This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site inspection was posted.
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: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: SF TIKES ACADEMY	FACILITY NUMBER: 384002757
	VISIT DATE: 11/15/2019

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At 1:10pm on November 15, 2019, LPA inspected the Multi-Purpose Room, Outdoor Playground. Per director, multipurpose is used as additional area for indoor games. Multipurpose room is free of hazards or dangerous conditions. Outdoor playground, located in the back of the facility, is completely enclosed. Playground is equipped with children’s blocks, tricycles and toys that are in good repair. Playground has rubber padded floors for increase safety. Outdoor playground is kept clean and free of debris and hazardous items. Per director, children bring their own water bottles outside during play and facility uses refillable water containers. Each child's bottle is labeled with his/her name.

Facility roster, Seven children and five personnel records were reviewed. All children and personnel files are complete. Staff CPR/ 1^st aid certification is current expiring: 04/2020. Emergency drills are done every 6 months, with the last drill conducted on, 7/11/2019, properly logged. Children's medication, located in the classroom, was inspected and is current. LPA Gomez observed licensing information and waiver is properly posted in facility lobby. Facility food menu is current and posted.

Director submitted updated: Facility IMS Plan, School Year Calendar and LIC 610 during today's inspection.

Incidental Medical Services (IMS) was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

During inspection,

· 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.
· Director was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
· Director was reminded about the Provider Information Notices (PINs) on CCLD website.
Licensee was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov

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SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

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