384002757-12-13-2022-05-CC-LGOZ-CM3SBZ-20221213124445

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002757
Report Date: 12/13/2022
Date Signed: 12/13/2022 12:45:11 PM

Document Has Been Signed on 12/13/2022 12:45 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
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: 62	DATE:	12/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Sarah Shimkunas		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/13/2022 at 8:45AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Sarah Shimkunas. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. This program is a preschool program with toddler option. Present was the Director and 10 staff supervising 62 children. Staff have criminal record clearances on file. Children present had been signed in by authorized representative. Preschool program currently utilizes five classrooms: Grasshopper/Toddler Room, 18 -36 months old; Koala, 4- 5 year old; Flamingo, 2-3 year old; Fish; 2-3 year old; Elephant, 4 years old; and one (shared) Outdoor Play Area. Per director, art and cat classrooms are not in use. Day and hours of operation are Monday- Friday, 8:00AM- 6:00PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 9:15AM., LPA observed the following: Facility was clean, orderly, with age-appropriate playthings available for the children. Floor and ground surfaces were free of obstructions. Furnishings, books and learning materials inspected were in proper repair; free of any sharp edges/loose parts. Cubbies are located in hallway for storage of belongings. Classrooms have child sized tables and chairs for snack and activities. Children’s bathrooms have adequate supplies for hand washing. Fixtures tested were operating condition. Toddler classroom's bathroom and outside play are scheduled separate to prevent intermingling. For napping services, stackable cots are stored in facility. Per director, napping supplies are washed weekly by families. Facility was the proper temperature, with ventilation and lighting. Detergents; cleaning supplies/ compounds; and toxins have been stored in the off-limit areas. Electrical outlets and trash bin have been covered. Classrooms have functioning carbon monoxide detector; smoke detector (Built-in); and fully charged fire extinguishers; 2A:10BC. First aid kit was reviewed during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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: 12/13/2022

NARRATIVE

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(Page 2)
At 9:30AM., LPA inspected facility’s outdoor play area. Outdoor area is completely enclosed. Area was free of debris or any hazardous plants. Rubber padding has been installed for increased safety. Per director, water services are provided with use of refillable water bottles and pitchers, brought outside by staff. Shed was reviewed during inspection.

LPA reminded director to remove tricycles with missing pedals and handle covers. Advisory Note: Technical Violation (LIC9102TV) was issued.

Facility’s snack preparation area was reviewed. Food items inspected are current and properly stored. Food preparation area was free of any liter or rubbish.

At 10:00AM, LPA reviewed the facility records including seven children’s files and 10 personnel files. Staff files reviewed included the: Notice of Employee Rights (LIC9052); Criminal Record Statement (LIC508); Transcripts; Proof of Immunization; and updated ‘Mandated Reporter Training’ Certification (AB1207).

Children’s files were reviewed and included: Consent for Medical Treatment (LIC627); Identification of Emergency Information (LIC700); Health History (LIC702); Notification of Parent’s Rights (LIC995); and Physician’s Report (LIC701).

Staff is documenting each 15- minute napping checks for qualifying infants in care. Logs were reviewed during inspection.

Director’s ‘Cardiopulmonary Resuscitation / First Aid’ certification was current, expiring: 5/2024. Emergency disaster drills are conducted by the facility, with last drill conducted, 10/13/2022, properly logged.

Required forms and posted in facility, including the: License; Outdoor Space Waiver; Notification of Parent’s Rights (PUB394); Updated Snack Menu; Updated Emergency Disaster Plan (LIC610); Passenger Safety Law’s form.
(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 12/13/2022

NARRATIVE

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Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

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

LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tool, please send them to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesource/community-care-licensing/inspection-process.

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

This report must be available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Any additional questions facility was advised to call Regional 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: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC809 (FAS) - (06/04)

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