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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003012
Report Date: 09/13/2019
Date Signed: 09/13/2019 02:17:18 PM

COMPREHENSIVE INSPECTION
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:SUNSHINE PRESCHOOL CENTERFACILITY NUMBER:
384003012
ADMINISTRATOR:AZAR, NAIFEHFACILITY TYPE:
850
ADDRESS:650 ANDOVER STREETTELEPHONE:
(650) 291-0512
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:30CENSUS: 3DATE:
09/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Azieb Debrezion TIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Farhan Bashir-Tariq met with the teacher, Azieb Debrezion (S1) , to conduct an Annual inspection and Case Management Inspection for toddlers’ option to be added onto the license on 9/13/19. Purpose of the inspection was explained. Present, there were 3 children in care with S1. Facility is operating within the capacity and is following staff child ratio on this day. Facility operates day care from Monday to Friday between 7:00 AM to 6 PM. Facility provides Breakfast, Lunch and 2 snacks.

LPA inspected the day care areas with S1 . Per S1, there are no pools, spas or other bodies of water at the facility. Facility has multiple smoke detectors, fully charged fire extinguishers, a Carbon Monoxide detector and a working telephone at the site. LPA was unable to test the detectors. Detectors were installed on the ceiling, which were to high and inaccessible. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. All toilets, hand washing facilities are in working condition with proper sanitation in place. All the materials and surfaces accessible to the children are clean. Play yard is free of hazards. All of the play structures are steady, in good repair and free of any loose parts. There is sufficient amount of soft cushioning under the play structures to prevent any fall injuries. Per S1, children bring water bottles and take the bottles and cups to the play yard. Stairs leading to the kitchen and back yard has been barricaded by installing baby gates at the bottom and top.

LPA reviewed the facility records. LPA reviewed all present children's files. Each child's file contains the records of immunization. S1 has record of valid CPR card in file: dated 8/13/19, which is valid for two years .
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
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 5
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: SUNSHINE PRESCHOOL CENTER
FACILITY NUMBER: 384003012
VISIT DATE: 09/13/2019
NARRATIVE
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Safe Sleep Regulation, Safe Sleep Environment and SIDS handouts were provided to the facility. LPA also provided a copy of form LIC 311A. LPA explained the facility about the requirement of licensing forms in children's files, Staff's files, Facility file and the documents that need to be posted.

LPA encouraged the facility to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

> Type B deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations: See LIC 809D.

This report and rights to comment and appeal were discussed with S1. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. Facility was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: SUNSHINE PRESCHOOL CENTER
FACILITY NUMBER: 384003012
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2019
Section Cited

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101215.1...Child Care Center Directors Qualifications and Duties
(b) All child care centers shall have a director.
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This requirement is not met as evidenced by records review.

This poses a potential health and safety risk to the children in care.
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Type B
09/27/2019
Section Cited

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101174...Disaster and Mass Casualty Plan.

(d) Disaster drills shall be conducted at least every six months.
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This requirement is not met as evidenced by records reviewing. S1 was unable to locate fire drill log. LPA spoke to owner on the phone about the log. Facility was unable to present one for LPA's reviewing.
This poses a potential health and safety risk to the children in care.
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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: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: SUNSHINE PRESCHOOL CENTER
FACILITY NUMBER: 384003012
VISIT DATE: 09/13/2019
NARRATIVE
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LPA measured the facility main day care area for the toddler’s option addition to the licensee. The measurement of the main day care adds up to 700 sqft, which allows the capacity of 20 children only. Facility does not have additional space for the toddlers options to be added in the preschool license. LPA spoke to the Licensee on the phone and Licensee stated, she plans to separate the room into two. Preschool and the toddler’s side. The wall has not been installed yet. Facility does not meet the requirement of number of bathrooms on each side for toddlers and preschool children.

Based on the Observation and Measurements taken today, Facility will not be recommended for toddler’s option addition to the Preschool license at this point.

LPA reminded the facility that All adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CDL or CA. ID prior to having any contact with children in care failure to do so could result in an immediate civil penalty.

LPA reminded the facility 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. LPA did not observe the records of immunization of staff present today

LPA reminded the facility, As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the training completion certificate for the owner.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: SUNSHINE PRESCHOOL CENTER
FACILITY NUMBER: 384003012
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2019
Section Cited

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1597.622...Employee and Volunteer Immunization
(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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This requirement is not met as evidenced by reviewing records for S1. Per S1, immunization records are not available for reviewing at the facility.

This poses a potential health and safety risk to the children in care.
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Type B
09/27/2019
Section Cited

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101218.1...Admission Procedures and Parental and Authorized Representative's Rights .
(e) At the time of acceptance of each child into care and for all children in care on August 7, 2002, the licensee shall give each parent or authorized representative a copy of the Notification of Parents' Rights (LIC 995).
(1) The licensee shall request the child’s parent or authorized representative to sign and date the acknowledgement-of-receipt statement at the bottom of the LIC 995 (8/02).
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 This requirement is not met as evidenced by reviewing the files of C1, C2 and C3. Parents and authorized representatives’ rights were missing in all three files.

This poses a potential health and safety or personal rights risk to the children in care.
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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: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5