384002978-10-23-2023-05-CC-LGOZ-CWVVU8-20231023164416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002978
Report Date: 10/23/2023
Date Signed: 10/23/2023 04:44:32 PM

Document Has Been Signed on 10/23/2023 04:44 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
SAN BRUNO CC RO, 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: 44	DATE:	10/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Andy Wong, Victoria Lam		TIME COMPLETED:	04:45 PM

NARRATIVE

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On 10/23/2023 at 12:40PM., Licensing Program Analysts (LPAs), Luis J. Gomez and Jonathan Tse met with Licensee, Andy Wong. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate a preschool-age program. Director, Victoria Lam arrived during inspection. Present was the director and 9 staff supervising 44 children. Children present had been signed in. Program utilizes four classroom: Discovery, 3-4; Petite, 2-3; Explorer, 4-5; Wonder, 3-4. and two Outdoor Play Areas. Per director, preschool program operates year around. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 12:45PM., LPA observed the following: Classrooms were clean, orderly, with age-appropriate playthings available for the children. Labeled cubbies are available for storage of children's belongings. Accessible furniture, books, and puzzles inspected were proper repair, and free of sharp corners or splinters. Classrooms had child- sized tables and chairs for seated activities.

LPA reminded facility to ensure cleaning wipes are stored in an off-limit area. Wipes were removed during inspection. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPA observed children’s bathrooms maintained clean, with fixtures in operating condition. Staff bathroom is located separate. For napping services, mats are stored in each classroom. Napping items were made of a cleanable material. Per licensee, children napping supplies are washed weekly. Facility has acceptable ventilation and lighting. Trash bins and outlets have coverings installed. Classroom were equipped with smoke/carbon monoxide combination detector, functioning telephone, and several fully charged fire extinguishers: 3A:40BC. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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 10/23/2023 04:44 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)

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: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 3:00PM., Based on record review, interview and observations, LPAs confirmed staff, S1, present without criminal record clearance on file. This poses a immediate health and safety risk to children in care.
	POC Due Date: 10/24/2023
	Plan of Correction
1 2 3 4	Facility will ensure staff, S1, received criminal record clearance by the due date: 10/24/2023. Proof of correction will be submitted to the department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/23/2023 04:44 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 2:10PM., Based on interviews and record review, LPAs confirmed facility's fixtures, used for drinking water, have not been tested for lead contamination levels. This poses a potential health and safety risk to children in care.
	POC Due Date: 11/06/2023
	Plan of Correction
1 2 3 4	Facility will ensure drinking water is tested for lead contamination levels by the due date: 11/6/2023. Proof of correction will be submitted to the department via email.

Type B

Section Cited

CCR

101238.2(d)(2)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:30PM., Based on observations, LPAs confirmed excessive leaves and debris located in the outdoor play area. This poses a potential health and safety risk to children in care.
	POC Due Date: 10/27/2023
	Plan of Correction
1 2 3 4	Facility will ensure leaves and hazardous items are removed from outdoor play area by due date: 10/27/2023. Proof of correction will be submitted to department 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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
	VISIT DATE: 10/23/2023

NARRATIVE

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(Page 2)
At 1:25PM., LPAs inspected the outdoor play area. Area was completely enclosed, with toys and playthings for the children. Tricycles inspected were in good repair. Shaded resting area is available to children.

At 1:30PM., Based on observations, LPAs confirmed excessive leaves and debris located in the outdoor play area.

During inspection, LPAs reviewed food preparation/storage room. Food items inspected had been properly stored. Area and items were observed clean and without trash or rubbish.

At 2:05PM LPAs reviewed facility records including 5 children’s files and 10 personnel files. Children’s files were reviewed and contained the: Consent for Emergency Medical Treatment (LIC627); Immunization Records, Identification and Emergency Information (LIC700); Personal Rights (LIC613A); Notification of Parent’s Rights (LIC995); and ‘Written Medical Assessments’.

Staff’s files were reviewed and contained the: Notice of Employee Rights (LIC9052); and Personnel Record (LIC501).

LPAs reminded director to ensure staff's proof of required immunization and teacher qualifications, are stored in the facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 2:10PM., Based on interviews and record review, LPAs confirmed facility's fixtures, used for drinking water, have not been tested for lead contamination levels.

At 2:30PM., Based on record review, LPAs confirmed current 'Mandated Reporter Training' Certification (AB1207) missing from facility files. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 3:00PM., Based on record review, interview and observations, LPAs confirmed staff, S1, present without criminal record clearance on file.

Staff CPR /First aid certification was current.
Emergency disaster drill are conducted monthly in each classroom. Last drill completed was on 10/16/2023, and is properly logged.

LPA observed required posting in facility, including the: Facility License; Emergency Disaster Plan (LIC610); Outdoor Space Waiver; Earthquake Preparedness Checklist; Notification of Parent’s Rights (PUB394); Updated Snack Menu (October); and Child Passenger Safety Laws (PUB369). (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
	VISIT DATE: 10/23/2023

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(Page 3)
For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Based on today's inspection, deficiencies were cited in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations. Exit interview, appeal rights and report was discussed with Licensee, Andy Wong. Signature of this form acknowledges 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.

Civil penalty of $100.00 was assessed during inspection.

This report must be made available in the facility for public review. Notice of site visit was given and must remain posted for 30 days. 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

LPAs were unable to print report during inspection. Copy of report and all pertaining documents will be sent to facility.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

LIC809 (FAS) - (06/04)

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