384002757-8-12-2021-05-CC-LGOZ-C5TQRX-20210812122439

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002757
Report Date: 08/12/2021
Date Signed: 08/12/2021 12:24:51 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: 0	DATE:	08/12/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Director, Sarah Shimkunas		TIME COMPLETED:	12:30 PM

NARRATIVE

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On 8/12/2021 at 9:10A.M., Licensing Program Analyst (LPA) Luis J. Gomez met with Director, Sarah Shimkunas at the facility. Purpose of inspection was explained and is an announced Case Management inspection to add toddler option component, for 12 children, to existing preschool license. Facility is requesting to designate Grasshoppers classroom as the toddler space. Present during inspection was the director, 12 staff and consultant. There were no children present during the inspection. Per director, facility is currently closed for break. Toddler option request was submitted to the Department on 7/23/2021. LPA Inspected facility with director for health and safety hazards.

LPA measured the following square footage in the Grasshopper Room (Classroom #3): 650 Sq. Ft. The total useable indoor square footage for the toddler option classroom room is 591.75 Sq. ft. divided by 35 sq. ft. equals 16 children. The proposed room can accommodate at least 12 children. Per director, toddler option children will share a bathroom, toilet and sink with preschool classroom (Fishes).

The classroom was observed today to be clean with age appropriate toys and equipment. There were several cubbies for children's personal belongings located in the hallway. All furnishing and equipment was observed to be safe and in good repair. There are garbage cans with tight fitting lids and outlets are covered. Classroom is equipped with a first aid kit. Emergency supplies are located in shed. Facility is equipped with fire extinguisher (3A:40BC), smoke/ carbon monoxide detector combo. All sinks accessible to children deliver water no warmer than 120 degrees. The shared bathroom is located next to toddler classroom. Bathroom is equipped with 1 sink (15 capacity) and 2 toilet (30 capacity) Diaper changing table is located within arms reach of a sink.

(REFER TO PAGE 2 FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: SF TIKES ACADEMY	FACILITY NUMBER: 384002757
	VISIT DATE: 08/12/2021

NARRATIVE

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(PAGE 2)

The outdoor play area measures 1672 Sq. ft. The total usable space is 1657Sq. Ft. divided by 75 sq. ft. allows for 22 children. LPA reminded director that the toddler's outdoor equipment must be age appropriate. The outdoor area surface is observed to be clean, in good condition. Per director, facility will implement and outdoor play schedule keeping the toddler option physically separate from the preschool. There is artificial turf that is padded underneath. There are no climbing structures on the toddler option outdoor space. Drinking water will be made accessible to children outdoors with the use of pitchers of fresh water and water bottles.

Director understands that the age range for the toddler option is 18 months to 3 years old and that authorized representatives must give written permission for their child to participate in the toddler option component. Ratio and staffing for the toddler option was discussed.

During inspection, director submitted snacking schedule, activity schedule for toddler component, article of incorporation, bathroom and playground schedule. LPA reviewed during today's with director: Care and Supervision of the Children, Child Discipline Procedures is Redirection and choices, Emergency Evacuation Procedures, Isolation of Sick Children, Napping Requirements, Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements.

Required postings were observed during today's inspection. Facility will conduct monthly disaster drills and a log will be maintained for review upon LPA request.

(REFER TO PAGE 3 FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: 08/12/2021

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(PAGE 3)

Director understands that preschool and toddler option children cannot commingle in the bathroom at any time. Director was reminded toddler option can accommodate a maximum group size of 12 toddler per grouping. Director understands that the children must be kept physically separation from the preschool age children at all times. Director understands that the toddler option children cannot commingle on the preschool in the outdoor space. Food service was discussed and will not be provided by the center.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. For IMS information see Title 22 Regulations sections 101173 and 101226. The following information regarding 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: http://www.ada.gov/childqanda.htm

Prior to recommendation for approval of toddler option component, Facility must complete the following:-

Submit Fire Clearance Approval
Submit Administrative Organization (LIC309)

No deficiencies were cited during today's inspection. This report and rights to comment and appeal were discussed. This report must be available in the facility for public review. Notice of site inspection was posted. Facility 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: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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