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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004003
Report Date: 03/23/2022
Date Signed: 03/23/2022 12:04:40 PM


Document Has Been Signed on 03/23/2022 12:04 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:HAMILTON SHELTER PROGRAMFACILITY NUMBER:
384004003
ADMINISTRATOR:PETROVA, DIANAFACILITY TYPE:
840
ADDRESS:260 GOLDEN GATE AVENUETELEPHONE:
(415) 342-2203
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:23CENSUS: 0DATE:
03/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Diana PetrovaTIME COMPLETED:
11:45 AM
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 On March 23, 2022 Licensing Program Analyst (LPA) Kaur conducted an unannounced, annual, required inspection. LPA met with center director, Diana Petrova and explained the purpose of the inspection. Present in the facility is director. Staff have criminal record clearance in file.

With director, LPA inspected the day care classrooms conference room and play yard. The facility is located in the building of a Hamilton Shelter. Facility provide after school care for children currently living on site. LPA observed classroom to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located in the classrooms, labeled with each child's individual names. Each classroom is equipped with a working telephone, an industrial fire alarm, a carbon monoxide detector, and a fire extinguisher, as well as emergency kits with first aid materials and emergency contact information.

All poisons, cleaning solutions and hazardous materials are stored inaccessible to children behind locked cabinets and facility's high shelves. Food is prepared by the chef in shelter. Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Play structures have resilient padding. Children are signed in and out of facility by parents' signatures.

LPA reviewed facility records, that included 1 child records and 2 staff records. LPA observed children's and staff's records to be complete. There is at least one teacher with valid CPR certificate. Last emergency drill was conducted on March 10,2022. Emergency drills are conducted at least once every 6 months and are properly logged and documented.

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SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2022
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: HAMILTON SHELTER PROGRAM
FACILITY NUMBER: 384004003
VISIT DATE: 03/23/2022
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Facility was informed 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 is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Directors were 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 a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility does not provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

No deficiencies were observed in today's inspection. The report was reviewed and signed by the Director, Diana Petrova. Today's report, 03/23/2022, and notice of site visit will be sent to the Licensee email at DPETROVA@HAMILTONFAMILIES.ORG by the close of business on 03/23/2022. Confirmation of receipt is required, and a notice of site visit must remain posted for 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
LIC809 (FAS) - (06/04)
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