384004003-5-9-2024-05-CC-HLEG-D54UG7-20240509153353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004003
Report Date: 05/09/2024
Date Signed: 05/09/2024 03:34:01 PM

Document Has Been Signed on 05/09/2024 03:34 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:	HAMILTON SHELTER PROGRAM		FACILITY NUMBER:	384004003
ADMINISTRATOR:	PETROVA, DIANA		FACILITY TYPE:	840
ADDRESS:	260 GOLDEN GATE AVENUE		TELEPHONE:	(415) 342-2203
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94102
CAPACITY:	23	CENSUS: 0	DATE:	05/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Diana Petrova		TIME COMPLETED:	03:45 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 5/9/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit to the Child Care Center (CCC) listed above. LPA met with the Director, Diana Petrova, and explained the purpose of the visit. No children were present during today’s visit. The director present at the CCC received criminal record clearance from the department. LPA observed that all required documents, such as the facility license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities, were displayed in the CCC. LPA observed that the last emergency disaster drill was conducted on 4/4/2024 and properly recorded. According to the director, the CCC provides snacks to the children. LPA observed that snacks were available at the CCC. LPA and the director conducted an inspection to identify potential health and safety hazards. LPA observed that the inside of the CCC was clean, safe, sanitary, and in good repair. The CCC is equipped with fully stocked first aid kits, functioning smoke and carbon monoxide detectors, and fully charged fire extinguishers. LPA observed that the classrooms were equipped with age-appropriate toys, furniture, and educational materials. LPA observed that each child has an individual permanent or portable storage space for his/her clothing and personal belongings at the CCC. LPA observed bathrooms to be clean and in working condition. LPA observed that the toilets and handwashing facilities at the CCC were in safe and sanitary operating condition. LPA observed that poisons, cleaning solutions, and chemicals were stored in a janitorial closet, which is off-limits to the children. See Page 2

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAMILTON SHELTER PROGRAM	FACILITY NUMBER: 384004003
	VISIT DATE: 05/09/2024

NARRATIVE

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LPA observed that a fence enclosed the outdoor playground, and the equipment was in good condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs falls. LPA observed that the CCC did not have any pools, spas, or other types of bodies of water in the outdoor area.

LPA reviewed five children’s files and confirmed that all five children have complete files that include their emergency contact and medical information.

LPA reviewed the director’s files and confirmed that all required forms were present. LPA found that the director possesses a current Pediatric First Aid/CPR certification expiring on 9/2025.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Director was reminded that all adults 18 and over, 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.

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

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAMILTON SHELTER PROGRAM	FACILITY NUMBER: 384004003
	VISIT DATE: 05/09/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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 informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inforesources/community-care-licensing/inspection-process

During the visit, the director requested an age change to third grade and above for their license. LPA reviewed the documents and updated the age in the system.

No deficiencies were issued today during LPA's visit.

A copy of today’s report was given to the Director, Diana Petrova.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Diana Petrova.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC809 (FAS) - (06/04)

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