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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003012
Report Date: 06/15/2023
Date Signed: 06/15/2023 12:52:48 PM


Document Has Been Signed on 06/15/2023 12:52 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 CHILD CARE, 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: 5DATE:
06/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Naifah Azar TIME COMPLETED:
12:55 PM
NARRATIVE
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On 6/15/2023 at 8:35AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Nancy Azar. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. This program is a preschool program with toddler option. Present was the Licensee and one staff supervising 5 children. Staff have their criminal record clearances on file. Children present have been signed in by authorized representative. Preschool program currently utilizes two classrooms: Toddler Area, 18 -36 months old; Preschool Classroom, 2- 5 years old, Upper Classroom, and one (shared) Outdoor Play Area. Day and hours of operation are Monday- Friday, 8:00AM- 5:00PM. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 8:45AM., LPA observed the following: Facility was clean, orderly, with age-appropriate playthings available for the children. Floor and ground surfaces were free of obstructions. Cubbies are located in entry way for children's belongings. Furnishings, books and learning materials inspected were in proper repair; and free of any sharp edges/loose parts.

LPA reminded licensee to have water readily accessible to children inside and outside. Advisory Note: Technical Violation (LIC9102TV) was issued.

Classroom has child sized tables and chairs for snack and activities. Children’s bathrooms have adequate supplies for hand washing. Fixtures tested were operating condition. For napping services, napping mats, and infant plan pens (with tight-fitting sheets) are stored in facility. Facility was the proper temperature, with ventilation and lighting. Detergents; cleaning supplies/ compounds; and toxins have been stored in the off-limit areas. Electrical outlets and trash bin have been covered. Classrooms have functioning carbon monoxide/ smoke combination detector (Built-in); and fully charged fire extinguishers; 2A:10BC. First aid kit was reviewed during inspection. (REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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 06/15/2023 12:52 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: SUNSHINE PRESCHOOL CENTER
FACILITY NUMBER: 384003012

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2023

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
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At 9:10, Based on record review and interviews, LPA confirmed facility has not tested drinking water for lead contamination levels.
POC Due Date: 06/22/2023
Plan of Correction
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Licensee will have fixtures used for drinking water and food preparation tested for lead contamination levels by the due date: 6/22/2023.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:00AM., Based on record review, LPA confirmed staff's proof of required immunization are missing from the personnel records. This poses a potential health and safety risk to children in care.
POC Due Date: 06/26/2023
Plan of Correction
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Licensee will ensure staff's proof of required immunization is stored is the personnel files by the due date: 6/26/2023. Proof of correction will be submitted to the 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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 10


Document Has Been Signed on 06/15/2023 12:52 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: SUNSHINE PRESCHOOL CENTER
FACILITY NUMBER: 384003012

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.4(a)(2)
Preschool Program with Toddler Component
(2) The toddler program shall be conducted in areas physically separate from those used by older or younger children. Space planning and usage for the toddler component shall be governed by the provisions of Section 101438.3. Plans to alternate use of outdoor play space must be approved by the Department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 9:20AM., Based on observations and interviews, LPA confirmed infant-age child co-mingling between the toddler component and preschool program.
POC Due Date: 06/19/2023
Plan of Correction
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Licensee will ensure children enrolled in facility's toddler component and preschool program remain complete separate groups at all times. Licensee will submit plan of operation, handbook, and updated activity schedule to the Department by the due date: 6/19/2023.
Type B
Section Cited
CCR
101429(a)(2)(C)(4)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: (4) Initials of person who conducted each check

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 12:00PM. Based on observations, record review, and interview, LPA confirmed licensee is not documenting infant napping conditions for each 15 minute review. This poses a potential health and safety risk to children in care.
POC Due Date: 06/22/2023
Plan of Correction
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Licensee will begin documenting napping conditions for napping infants in care by the due date: 6/22/2023. Proof of correction will be submitted to the 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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 10


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SUNSHINE PRESCHOOL CENTER
FACILITY NUMBER: 384003012
VISIT DATE: 06/15/2023
NARRATIVE
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(Page 2)
At 9:00AM., LPA inspected facility’s outdoor play area. Outdoor area is completely enclosed. Area was free of debris or any hazardous plants. Rubber padding on ground has been installed for increased safety. Area has accessible shading for children.

At 9:10AM, Based on record review and interviews, LPA confirmed facility has not tested drinking water for lead contamination levels.

At 9:20AM., Based on observations and interviews, LPA confirmed infant-age child co-mingling between the toddler component and preschool program.

At 9:40AM, LPA reviewed the facility, staff and children’s files.

Staff files reviewed included the: Criminal Record Statement (LIC508); and Required Transcripts.

At 10:00AM., Based on record review, LPA confirmed staff's proof of required immunization are missing from the personnel records.

LPA reminded licensee to ensure staff's proof of 'Mandated Reporter Training' (AB1207) certification is stored in personnel records. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPA reminded licensee to maintain all required forms in the personnel file including: LIC9108, LIC503 and LIC9052.

At 10:10AM., Based on record review, LPA confirmed 3 of 5 children present missing facility file with required forms and proof of immunization. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 10:20AM., Based on interviews, observations and record review, LPA confirmed combination center does not have site director. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 10:40AM., Based on record review, LPA confirmed staff present without CPR/1st aid certification. Advisory Note: Technical Violation (AB1207) was issued.

Emergency disaster drills are conducted on site, with the last drill properly logged: 1/20/2023.

At 12:00PM. Based on observations, record review, and interview, LPA confirmed licensee is not documenting infant napping conditions for each 15 minute review.

Facility’s snack/ food preparation area was reviewed. Food items inspected are current and properly stored. Food preparation area was free of any liter or rubbish. Per licensee, food is brought by families. LPA reminded licensee to ensure children food containers are labelled with the child’s name.

Required forms and posted in facility, including the: License; Outdoor Space Waiver; Notification of Parent’s Rights (PUB394); Updated Emergency Disaster Plan (LIC610); and Passenger Safety Law’s form.
(REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC809 (FAS) - (06/04)
Page: 7 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SUNSHINE PRESCHOOL CENTER
FACILITY NUMBER: 384003012
VISIT DATE: 06/15/2023
NARRATIVE
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(Page 3)
Licensee 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.

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

LPA discussed the safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations and cited on 809D. Exit interview, plan of correction, appeal rights, and report was reviewed with Licensee, Nancy Azar, 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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC809 (FAS) - (06/04)
Page: 8 of 10