384004341-6-1-2021-05-CC-CQUO-C3KNHV-20210601102922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004341
Report Date: 05/11/2021
Date Signed: 06/01/2021 10:29:30 AM

Document Has Been Signed on 06/01/2021 10:29 AM - 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:	TEL HI MISSION BAY CHILD CARE		FACILITY NUMBER:	384004341
ADMINISTRATOR:	LUU, CONNIE		FACILITY TYPE:	830
ADDRESS:	188 PIERPOINT LANE		TELEPHONE:	(415) 517-0120
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94158
CAPACITY: 9	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/11/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Connie Luu		TIME COMPLETED:	01:30 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	Licensing Program Analysts (LPAs) Glenn Schnell and Catrina Quimbo met with applicant Connie Luu today for a pre-licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is requesting a combination center of a preschool license with toddler option and an infant license. The applicant is requesting 40 preschool children (ages 2 years to entry into first grade) with a toddler option of 12 children (ages 18 months to 36 months). The applicant is also requesting for 9 infants (ages 3 months to 18 months). The facility will operate Monday – Friday from 7:30am to 6:00pm. Children will be signed in and out with an electronic signature. The designated director/site supervisor for the facility is Mimi Tom. The facility was inspected for health and safety hazards and measured to calculate capacity. Indoor: There is one classroom that will be used for the infant program. Room # 4 (Classroom #117- Seal Pups) square footage was calculated for 344.162 sq ft divided by 35 sq ft equaling 9 students. Total useable classroom square footage for the infant program is 9 students. Bathroom #2 is to be shared among toddler option classroom and infant program classroom. In shared bathroom between Room #3 and Room #4 are 2 toilets, 1 adult sink, 2 changing tables and 2 adult sinks within arm’s reach of changing table. Total allowable capacity for toilets is 30 children and 15 children for sinks. Disposable diapers and wipes to be provided by parents. Applicant was advised toddler option children and infant program children are to use bathroom separately. All sinks accessible to children are not warmer than 120 degrees. Continue Report on Page 2......

Cindy Interiano
Catrina Quimbo
	DATE: 05/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: TEL HI MISSION BAY CHILD CARE	FACILITY NUMBER: 384004341
	VISIT DATE: 05/11/2021

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
26
27
28
29
30
31
32

The facility contains additional indoor space of a “Quiet Room”, “Multipurpose Room Area #1” and “Multipurpose Room Area #2”. The “Quiet Room” is used as an isolation area for sick children. Staff bathroom will be used for sick children. Applicant was advised children using the “Quiet Room” and staff bathrooms must always be supervised. The “Multipurpose Room Area #2” is to be utilized as additional activity space and was calculated for 254.411 sq ft divided 35 sq ft equaling 7 students. “Multipurpose Room Area #2” consists of 1 sink. Due to room being a multipurpose room and not used on a regular basis, this space is not included in total square footage/ capacity.

The indoor space for children was observed to be clean and all furnishing, toys and equipment observed to be safe, age appropriate and in good condition. Inside and outside the classroom is sufficient storage space for children’s personal belongings. Cribs and cots are to be utilized for napping children. Program will provide sheets and blankets. Bedding will be laundered daily. Room #4 has flooring that is padded with sufficient cushioning. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detector. First Aid Kit and emergency supplies are located in the classroom, inaccessible to children. Garbage cans have tight fitting lids. The facility is adequately ventilated and free of insects and bugs. Window screens are new and in good condition. Cleaning products are stored in the classroom’s high cabinets, inaccessible to children.

The facility has one main Kitchen Area and 2 designated “Prep Areas”. The main Kitchen Area is equipped with a stove, 2 refrigerators, 1 sink, 1 microwave, 1 dishwasher and 1 washer and dryer. For food service, parents to provide infants with puree, bottles and nipples. Infant’s food and belongings will be labeled with child’s name and date and will be stored in designated Prep Area #2, shared among Room #3 and Room #4. Prep Area#2 is equipped with 1 refrigerator, 1 sink and 1 dishwasher. Children’s items to be sanitized and sent home daily. Once children begin to transition to table food, program will provide dry snacks. The program will provide water in sippy cups for children to drink water indoors. Applicant was reminded that cleaning products and other chemicals are not to be stored with food.

Continue Report on Page 3.....

SUPERVISOR'S NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: TEL HI MISSION BAY CHILD CARE	FACILITY NUMBER: 384004341
	VISIT DATE: 05/11/2021

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
26
27
28
29
30
31
32

Medications with children’s individual names and required documentation will be stored in classroom’s high cabinets. Medications that require refrigeration will be stored in shared Prep Area #2’s refrigerator. This facility will provide Incidental Medical Services (IMS). LPA reviewed storage area for medication and equipment/supplies and reviewed forms that will be used. 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

Outdoor: The outdoor area measures 706.008 sq ft divided by 75 sq ft equaling 9 children. The outdoor area includes 1 adult sink. An at least four-foot high fence enclosed the outdoor infant area to be used. The playground was observed to be clean, safe and equipped with age appropriate toys and equipment. Soft cushioning and turf are used as padding for infant crawling. Drinking water for outdoor use will be made accessible to children by sippy cups provided by parents. Adequate shade is provided by designated tarp/umbrellas.

The facility will conduct monthly disaster drills and a log will be maintained for review upon request. The following items were reviewed as part of today’s visit: Record keeping for staff, children and facility records, Care and Supervision of the Children, Child Discipline Procedures-staff will use redirection, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements (safe sleep regulations), Food Service, Transportation-neighborhood walks/field trip, Parents Rights and Reporting Requirements. Required postings were observed during today’s inspection. Facility will conduct monthly disaster drills and a log will be maintained for review upon request. The requirement for Lead Water Testing was discussed (H&S Code 1597.16).

As of May 11, 2021, the fire inspection has not been approved. LPA discussed program’s COVID-19 protocol and required postings. Applicant was informed that access to available Personal Protective Equipment (PPE) may be available through the local child care resource and referral agency.
Continue Report on Page 4......

SUPERVISOR'S NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: TEL HI MISSION BAY CHILD CARE	FACILITY NUMBER: 384004341
	VISIT DATE: 05/11/2021

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
26
27
28
29
30
31
32

An electronic copy of this 4 page report was emailed to applicant, Connie Luu, on May 18,2021. Applicant was asked to review the report and return a signed copy of the report to LPA Quimbo.

LPA will recommend licensure of this facility for a capacity of 9 children once the following is received:

-Approved Fire Safety Clearance
-In-service Training Plan for Staff
-Revised Parent Handbook
-Revised Admissions Policy
-Revised Personnel Policies
-LPA receives a signed copy of this 4 page pre-licensing report.

SUPERVISOR'S NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4