384002978-10-3-2022-05-CC-LGOZ-CJUV5H-20221003160758

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002978
Report Date: 10/03/2022
Date Signed: 10/03/2022 04:09:03 PM

Document Has Been Signed on 10/03/2022 04:09 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:	PETITE EXPLORER PRESCHOOL		FACILITY NUMBER:	384002978
ADMINISTRATOR:	LAM, VICTORIA		FACILITY TYPE:	850
ADDRESS:	722 SOUTH VAN NESS		TELEPHONE:	(415) 872-9185
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY:	66	CENSUS: 43	DATE:	10/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Andy Wong, Victoria Lam		TIME COMPLETED:	04:15 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 10/3/2022 at 11:50AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Andy Wong. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Director, Victoria Lam arrived during inspection. Present was the Licensee, Director and 8 staff supervising 43 children. All staff their have criminal record clearances on file. Children present have been signed in. Preschool program utilizes four classroom: First Floor: Wonder Room, 2-3 year old; Second Floor: Explorer Room, 4- 5 year old; Petite Room, 2- 3 year old; Third Floor: Discover Room, 3-4 years old; and two, Outdoor Play Areas. Day and hours of operation are Monday- Friday, 8:00AM- 5:30PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 12:10PM., LPA observed the following: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces were free of obstructions leading to the exits. Accessible furniture, changing tables, and materials inspected were in proper repair. Each classroom is equipped with labeled cubbies for storage of children’s belongings. Classrooms have several child sized tables and chairs for snack and planned activities. Children’s bathroom has adequate supplies for hand washing; fixtures tested were operating condition. Staff bathroom is located separate. For napping services, foldable mats are stored in each classroom. Per director, napping supplies are washed weekly by families. Facility has acceptable ventilation and lighting. Detergents; cleaning supplies/ compounds; and toxins are stored in the off-limit areas. Electrical outlets, heater vents, and trash bin are all covered. Classrooms had functioning carbon monoxide detectors; and three (fully charged) fire extinguishers; 3A:40BC. Per director, smoke detectors are built into the building. Facility’s first aid kit was reviewed. Facility’s food prep area was reviewed during inspection. Food items inspected were current and properly stored. At 12:45PM., LPA inspected facility’s outdoor play area. Outdoor area is completely enclosed with tall fencing. Area free of debris or hazardous plants. Per director, water services are provided with use of refillable water bottles, brought outside by staff. LPA reminded facility to ensure all children water bottles are labeled with the corresponding child’s name. (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: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
	VISIT DATE: 10/03/2022

NARRATIVE

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At 12:50PM., Based on observations, LPA observed tricycle with broken handlebar in the outdoor play area. Advisory Note: Technical Violation (LIC9102TV) was issued. Broken item was removed during inspection.

At 1:20PM, LPA reviewed the facility records including 8 children’s files and 8 personnel files. Staff files reviewed included the: Notice of Employee Rights (LIC9052); Criminal Record Statement; and Declaration to Report Suspected Child Abuse (LIC9108).

LPA reminded director to ensure all staff proof of required immunization are stored in the personnel files.

At 1:30PM., Based on record review, LPA confirmed updated 'Mandated Reporter Training' (AB1207) certification missing from staff files. Advisory Note: Technical Assistance (LIC9102TA) was issued during inspection.

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

Staff’s Cardiopulmonary Resuscitation / First Aid certification was current, expiring: 11/2023. Emergency disaster drills are conducted by the facility, with last drill done on, 8/23/2022, properly logged.

Required forms and posted in facility, including facility’s Childcare License; Outdoor Space Waiver; Child Passenger Safety Laws; Notification of Parent’s Rights (PUB394); Outdoor Space Waiver; and Emergency Disaster Plan (LIC610). LPA reminded director to ensure updated food menu is posted in the facility.

Children’s medication was reviewed and incident medical services (IMS) 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.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
	VISIT DATE: 10/03/2022

NARRATIVE

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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, Victoria Lam 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: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

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