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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004296
Report Date: 03/30/2022
Date Signed: 03/30/2022 12:57:03 PM


Document Has Been Signed on 03/30/2022 12:57 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:MIO-PRESCHOOLFACILITY NUMBER:
384004296
ADMINISTRATOR:CANDICE CACERASFACILITY TYPE:
850
ADDRESS:2235 MISSION STREETTELEPHONE:
(415) 655-3756
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:15CENSUS: 12DATE:
03/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Candice CacerasTIME COMPLETED:
01:15 PM
NARRATIVE
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On 3/30/2022 at 9:00A.M., Licensing Program Analyst (LPA), Luis Gomez met with Director, Candice Cacaras. Purpose of the inspection was explained and was for an unannounced, Annual/ Random inspection. Present was the Director and 2 staff supervising 12 children. All children present had been properly signed in. Staff present had their criminal record clearances on file. Program utilized one, multipurpose classroom space. Days and Hours of operation are Monday- Friday 7:30am- 5:30pm. Program operates year around. LPA inspected entire facility with director for health and safety hazards.

At 9:10 A.M., the following was observed: Classroom was clean and orderly with age-appropriate books, blocks and supplies available for the children. Classroom had been divided into separate spaces for each activity. Floor and ground surfaces, leading to the exits, were free of any obstructions. All children’s furniture and playthings inspected were in good repair. For added storage, facility was equipped with individual cubbies for each child's belongings. Classroom had several child sized tables and chairs for snack and activities. For napping services, napping mats are stored in facility and labelled with the pertaining child’s name. Per director, napping supplies and sheets are sent home weekly to be washed. Classroom was the proper temperature, with ventilation and lighting. Children’s bathroom was reviewed during inspection. Bathroom fixtures tested were in operating condition. Children's bathrooms had adequate supplies. Staff bathroom was located in separate area. Facility’s cleaning detergents, disinfectants, wipes, spray bottles and all other toxins had been made inaccessible and stored on high shelf. Accessible outlets had been properly covered. LPA reminded Director to ensure all accessible trash bins have tight-fitting covers installed. Facility had functioning telephone service, smoke/ carbon monoxide combination detector and fire extinguishers (3A:40BC) located in entry way. Facility’s first aid kit was reviewed during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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 03/30/2022 12:57 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: MIO-PRESCHOOL

FACILITY NUMBER: 384004296

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, LPA confirmed staff's mandated reporter training certifications (AB 1207) had expired. This poses a potential health and safety risk to children in care.
POC Due Date: 04/08/2022
Plan of Correction
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Director will ensure all staff have updated the required Mandated Reporter Training Certification by the due date: 4/8/2022. Proof of correction will be submitted to the department via email.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, LPA confirmed director’s pediatric cardiopulmonary resuscitation and pediatric first aid certification had expired. This poses a potential health and safety risk to children in care.
POC Due Date: 04/15/2022
Plan of Correction
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Director will renew their CPR/ first aid certification by the due date: 4/15/2022. 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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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: MIO-PRESCHOOL
FACILITY NUMBER: 384004296
VISIT DATE: 03/30/2022
NARRATIVE
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(PAGE 2)

For water services, LPA observed accessible children’s water bottles were properly labelled and located in playroom. Per director, children’s water bottles are refilled by staff from a non-contained source.

At 10:00A.M., LPA review the facility records, ten children's files and three personnel files. Staff's file included the: Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), Transcripts and Notice of Employee Rights (LIC9052).

At 10:20A.M., Based on record review and interview, LPA confirmed staff's required proof of immunization and TB assessment missing from facility files. During inspection, Advisory Note: Technical Violation (LIC9102) was issued.

At 10:30A.M., Based on interview and record review, LPA confirmed staff's mandated reporter training certifications (AB 1207) had expired.

Children's files reviewed were complete and included the: Health History (LIC702), Identification of Emergency Information (LIC700), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995) and Immunization Records.

Per director, required emergency drills are conducts every six months, with the last drill done on 3/15/2022. LPA reminded director to ensure disaster drills are properly logged.

At 10:35A.M., Based on interview and record review, LPA confirmed director’s pediatric cardiopulmonary resuscitation and pediatric first aid certification had expired.

Per director, families provide child lunches. LPA reminded director to ensure container brought from home are properly labelled with the child’s name. Food available was reviewed and was current.

All required posting were observed in the entry way, included Childcare License, Notification of Parents Rights (PUB393), Updated Emergency Disaster Plan (LIC610) and Approved Outdoor Space Waiver. Per director, day-care children are walked to Mission Park Playground.

During inspection, LPA reviewed children’s medication. Medication review was current. Per director, she will communicate with families regarding current IMS Plan. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
Page: 4 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: MIO-PRESCHOOL
FACILITY NUMBER: 384004296
VISIT DATE: 03/30/2022
NARRATIVE
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(PAGE 3)

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 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.

Incidental Medical Services (IMS) policy was discussed. 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

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 attached 809D. Exit interview and plans of correction were discussed with Director, Candice Caceras and her signature of this form acknowledges receipt of these documents.



The 'Notice of Site Visit' form was provided to director and must remain posted for 30 days.

Appeal rights and rights to comment were discussed. This report must be available in the facility for public review. For additional questions, facility was advised to contact the Community Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
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