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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002760
Report Date: 10/26/2022
Date Signed: 10/26/2022 06:24:46 PM


Document Has Been Signed on 10/26/2022 06:24 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:BUENA VISTA CHILD CARE, INC.(SA)FACILITY NUMBER:
384002760
ADMINISTRATOR:SCHLICKER, SHERIFACILITY TYPE:
840
ADDRESS:1266 FLORIDA STREETTELEPHONE:
(415) 283-5545
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:90CENSUS: 92DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Rocelle Celedon, Judith GarciaTIME COMPLETED:
06:30 PM
NARRATIVE
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On 10/26/2022 at 1:25PM., Licensing Program Analyst, Luis J. Gomez met with Program Director, Rochelle Celedon and Administrative Director, Judith Diaz. The purpose of the visit was explained and is for an unannounced; annual random inspection. Program offers after-school care, which operates at St. Peter’s Catholic School. Program is utilizing three rooms: Afterschool Room; Classroom #1, #2, Middle School Room; Classroom #3, the Library and one, shared, outdoor play yard. Days and hours of operation are: Monday, Tuesday, Thursday, Friday: 3:00pm- 5:30pm and Wednesdays, 12:30- 5:30pm. Present were the directors and 12 staff supervising 92 children. LPA inspected the facility, indoor and outdoor, with director for health and safety hazards.

At 1:38PM., Based on record review, observations and interview, LPA confirmed facility is operating over capacity limit, with 92 children in care at one time.

At 1:40PM., LPA observed the following: Classrooms have books, supplies and materials available for the children. Classrooms are equipped with several tables and chairs for activities. Classrooms have acceptable ventilation and lighting. Facility had storage cubbies in the hallway for children’s belongings. Classrooms are equipped Carbon Monoxide Detector; Smoke Detector and fully charged fire extinguisher (3A40BC) located in the hallway.

At 2:00PM., LPA inspected the outdoor play areas and children’s bathrooms. Bathrooms equipped inspected was maintained and in good repair. Water is available for the children with use of water station and disposable cups. Children’s bathroom located outside and were reviewed. Fixtures tested were in operating condition. Bathroom had adequate supplies for hand-washing.

At 2:05PM., Based on observations and interviews, LPA confirmed facility is using unapproved classrooms.


At 2:15PM., Based on observations, LPA confirmed two children left unsupervised in facility classroom.
(REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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Document Has Been Signed on 10/26/2022 06:24 PM - It Cannot Be Edited

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: BUENA VISTA CHILD CARE, INC.(SA)
FACILITY NUMBER: 384002760

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229(a)(1)
Responsibility For Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, LPA confirmed two children left unsupervised in facility classroom. This poses a potential health and safety risk to children in care.
POC Due Date: 11/11/2022
Plan of Correction
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Licensee will conduct training with facility staff to review requirement for constant supervision. Agenda with proof of correction will be submitted to the department by the due date: 11/11/2022
Type B
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA confirmed staff member, S1, present without proper facility association. This poses a potential health and safety risk to children in care.
POC Due Date: 10/28/2022
Plan of Correction
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Licensee will submit background transfer form (LIC9182) an current I.D. to the CCL office by the due date: 10/28/2022. Proof of correction will be submitted via email.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/26/2022 06:24 PM - It Cannot Be Edited

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: BUENA VISTA CHILD CARE, INC.(SA)
FACILITY NUMBER: 384002760

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(g)
Teacher Qualifications and Duties
(g) A photocopy of the teacher's Child Development Permit as specified in (c)(3) above, or a photocopy of the teacher's transcript(s) documenting successful completion of required course work, shall be maintained at the center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA confirmed teacher's proof of qualification are missing from staff files. This poses a potential health and safety risk to children in care.
POC Due Date: 11/18/2022
Plan of Correction
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Director will submit updated personnel roster (LIC500) to the department by the due date: 11/18/2022. Director will ensure all staff designated as teacher will have proof of qualification the staff's personnel file. Proof of correction will be submitted to the department via email.
Type B
Section Cited
CCR
101212(c)
Reporting Requirements
(c) The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interviews, LPA confirmed facility is using unapproved classrooms. This poses a potential health and safety risk to children in care.
POC Due Date: 11/04/2022
Plan of Correction
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Licensee will submit (original) updated Facility Sketch (LIC999), Emergency Disaster Plan and Letter of Intention by the due date: 11/04/2022.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 9


Document Has Been Signed on 10/26/2022 06:24 PM - It Cannot Be Edited

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: BUENA VISTA CHILD CARE, INC.(SA)
FACILITY NUMBER: 384002760

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101161
A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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1:45PM., Based on record review, observations and interview, LPA confirmed facility is operating over capacity limit, with 92 children in care at one time. This poses an immediate health and safety risk to children in care.
POC Due Date: 11/04/2022
Plan of Correction
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Director will immediately reduce enrollment to the required capacity limit of 90 children. Proof of correction will be submitted to the department via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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: BUENA VISTA CHILD CARE, INC.(SA)
FACILITY NUMBER: 384002760
VISIT DATE: 10/26/2022
NARRATIVE
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(Page 2)
At 2:30PM LPA review facility records including six children’s files and 10 personnel files. Staff files reviewed and included: Declaration to Report Suspected Child Abuse (LIC9108) and Notice of Employee Right (LIC9052).

At 3:50PM., Based on record review, LPA confirmed staff member, S1, present without proper facility association.

At 4:00PM., Based on record review, LPA confirmed teacher's proof of qualification are missing from staff files.

LPA reminded facility to ensure staff's proof of required immunization are stored in facility files. Advisory Note: Technical Violation (9102TV) was issued during inspection.

LPA reminded facility to ensure staff's updated ‘Mandated Reporter Training' (AB1207) certification is stored in the facility files. Advisory Note: Technical Violation (LIC9102TV) was issued during inspection.

Children’s files were reviewed included: Identification of Emergency Information; Health History (LIC702); Personal Right (LIC613A) Notification of Parent’s Rights (LIC995).

Present staff members had their current CPR/ 1st aid certification, which expires: 11/11/2023. LPA reminded facility to conducting (and document) emergency disaster drills every six months.

LPA observed updated snack schedule during inspection. Per director, food services are outsourced and brought to the facility daily.

All required posting were reviewed including the facility included the License, Parents Rights (PUB393), Emergency Disaster Plan (LIC610).

Administrator 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.


(REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: BUENA VISTA CHILD CARE, INC.(SA)
FACILITY NUMBER: 384002760
VISIT DATE: 10/26/2022
NARRATIVE
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(REFER TO 809C, FOR CONT.)
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 (REFER TO 809C FOR CONT.)

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, deficiencies were observed in areas evaluated according the Title 22 Division 12 of Ca. Code of Regulations and listed on the 809D pages. A copy of this report, exit interview, with the appeal rights was provided to directors, and signature of this form acknowledges the receipt of these documents.



Type “A” violation was issued today. Licensee was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

Notice of site visit was observed to be posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 9 of 9