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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002760
Report Date: 01/28/2020
Date Signed: 01/28/2020 07:17:16 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:BUENA VISTA CHILD CARE, INC.(SA)FACILITY NUMBER:
384002760
ADMINISTRATOR:SCHLICKER, SHERIFACILITY TYPE:
840
ADDRESS:1266 FLORIDA STREETTELEPHONE:
(415) 285-0221
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:90CENSUS: 77DATE:
01/28/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Rochelle Celdon, Judith DiazTIME COMPLETED:
07:30 PM
NARRATIVE
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Licensing Program Analyst, Luis J. Gomez met with Director, Rochelle Celedon Administrative Director, Judith Diaz. The purpose of the visit was explained and is for an unannounced annual inspection. This program is an after-school program, which operates year around at St. Peter’s Catholic School. Program utilizes three classrooms an outdoor play area, library and gymnasium. Hours of operation are Monday, Tuesday, Thursday, Friday: 3:00pm- 6:00pm and Wednesday 2:15- 6:00pm. Present is the director, administrative director and eight staff supervising 77 children. Facility is within capacity limits of the license. At 4:50pm on January 28, 2020 LPA Gomez observed the children on the daily sign-in sheet does not match number of children present. LPA Gomez inspected the facility with director for health and safety hazards.

At 4:00pm on January 28, 2020 LPA Gomez inspected the Classroom #1, Classroom #2, Classroom #3 and the outdoor play area. Classrooms have books, supplies and materials for the children. Classrooms are equipped with several child size tables and chairs. Classrooms have acceptable ventilation and lighting. Facility has several cubbies in the facility hallway for children’s belongings. At 4:33pm on January 28, 2020, LPA observed barbecue supplies in an accessible cabinet in Classroom #1. Room partition located in classroom #2, is the required height. At 4:39pm on January 28, 2020, LPA observed an exposed heater in classroom #2, accessible to children. Classrooms have a smoke detector and fully charged fire extinguisher (3A40BC) located in the hallway. At 6:15pm on January 28, 2020, LPA Gomez observed facility does not have a working carbon monoxide detector. LPA inspected the outdoor play areas for hazards and dangerous conditions. All equipment’s is maintained and in good repair. Water is readily available for the children with use of water fountains. Children’s bathroom located outside.

(Continuation on 809-C)

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: BUENA VISTA CHILD CARE, INC.(SA)
FACILITY NUMBER: 384002760
VISIT DATE: 01/28/2020
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During today’s inspection, LPA reviewed children’s files and personnel files. All children's reviewed files are complete. Staff CPR/ 1st aid certification is current expiring: 10/18/2021. LPA reminded director all staff must have the required mandated reporter training. Emergency Disaster Drill 9/1/2019. LPA reminded director to document all disaster drills conducted at the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Director was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Director was informed about the Provider Information Notices (PINs) on CCLD website. www.cdss.ca.gov



Based on today's inspection, deficiencies were observed in the areas evaluated and cited according to the Title 22 Division 12 of the Ca. Code of Regulations listed on the 809-D. Plan of Correction were reviewed and developed with administrator. An exit interview was conducted and a copy of this report was provided to, Rochelle Celedon, 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 MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 2 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: BUENA VISTA CHILD CARE, INC.(SA)
FACILITY NUMBER: 384002760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2020
Section Cited

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101229.1 Sign in Sign out. The person who signs the child in/out shall use his or her full legal signature and shall record the of day. This requirement not met as evidenced by.
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Based on interview with site director and a file review, LPA Gomez observed the children on the daily sign-in sheet does not match number of children present. This poses a potential health and safety risk to children in care.
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Director will submit proof of correction to LPA Gomez via email.
Type B
02/07/2020
Section Cited

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1596.954 Carbon Monoxide Detector required; inspection. Every licensed child care center must have one or more carbon monoxide detectors in the facility... This requirement is not met evidenced by
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Based on interview and observations conducted, LPA confirmed facility does not have a working carbon monoxide detector. This poses a potential health and safety risk to children in care.
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Director will submit proof of correction to LPA Gomez 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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
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: BUENA VISTA CHILD CARE, INC.(SA)
FACILITY NUMBER: 384002760
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

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101238(g) Building and Grounds. Disinfectants, cleaning solution, poisons and other items that can pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by.
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Based on observations conducted, LPA observed barbecue supplies in an accessible cabinet, located in Classroom #1. This poses an potential health and safety risk to children in care.
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Director will submit proof of correction LPA Gomez via email.

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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4