384004189-12-9-2022-05-CC-ACON-CLXRZK-20221209122803

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004189
Report Date: 12/09/2022
Date Signed: 12/09/2022 12:28:17 PM

Document Has Been Signed on 12/09/2022 12:28 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:	APPLE TREE CHILDREN CENTER-INFANT		FACILITY NUMBER:	384004189
ADMINISTRATOR:	LIN, SHUYING		FACILITY TYPE:	830
ADDRESS:	1331 HARRISON STREET		TELEPHONE:	(415) 695-4726
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94103
CAPACITY:	16	CENSUS: 8	DATE:	12/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	/Shuying Lin		TIME COMPLETED:	12:40 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 December 9, 2022 at 9:09 AM, Licensing Program Analyst (LPA) Cowan met with Teacher for an unannounced annual random inspection. Present today is 3 staff, and 8 infants at this time. Director is not present when LPA arrived. Director arrived at 9:40 AM to complete the inspection with LPA. Staff to child ratio was met on this day. The center operates Monday - Friday 8:30 AM to 5:30 PM. LPA inspected the infant day care area for health and safety hazards today. The center is clean, orderly and in good repair. There are no pools, spas or other similar bodies of water on site. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. All furniture and equipment are clean and in good working condition. The center's furniture and equipment are age appropriate. There is a sufficient quantity of cribs, table/chairs, and changing tables meet the capacity. Bedding is sent home once a week for cleaning by parents. Bottles and other items provided by the parents are labeled and stored appropriately. Food and formula are provided by parents. Changing tables are within an arm’s reach of a sink. The center has a installed carbon monoxide and smoke detector. LPA observed infants were supervised by staff in the classrooms and in the napping area. All solid waste storage containers have secure lids. At 9:18 AM, LPA observed that sleeping infant was covered with a blanket. This is a potential risk to children in care. A type B citation is issued for this deficiency. At 9:34 AM, Staff files were reviewed. Both staff's and children's files are complete with all required Licensing documents At least one staff member on site has current CPR/First Aid certification. LPA discussed Emergency Evacuations, Guardian for managing associations, facility's IMS Policy to be submitted, and Safe Sleep Regulations with site director. See next page ...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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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Document Has Been Signed on 12/09/2022 12:28 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: APPLE TREE CHILDREN CENTER-INFANT	FACILITY NUMBER: 384004189
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101439.1(f)

Infant Care Center Sleeping Equipment

(f) Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in one sleeping infant was covered with a blanket during nap time which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Director agrees to train staff on Safe Sleep Regulations and email to LPA meeting agenda with the signatures of all that attend.

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: APPLE TREE CHILDREN CENTER-INFANT	FACILITY NUMBER: 384004189
	VISIT DATE: 12/09/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Director 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 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.

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-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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.

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 certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

>See next page for deficiencies

An exit interview conducted and report was reviewed with site director.

This report must be available in the facility for public review. Notice of site visit is to be 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.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

LIC809 (FAS) - (06/04)

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