384004392-5-26-2021-05-CC-HRCO-C3DW5A-20210526165848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004392
Report Date: 05/21/2021
Date Signed: 05/26/2021 05:00:40 PM

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:	MISSION HEAD START- LA FENIX AT 1950(INF)		FACILITY NUMBER:	384004392
ADMINISTRATOR:	URIARTE, MERCEDES		FACILITY TYPE:	830
ADDRESS:	1954 MISSION ST. STE. A		TELEPHONE:	(415) 206-7752
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94103
CAPACITY:	22	CENSUS: 0	DATE:	05/21/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Mercedes Uriarte		TIME COMPLETED:	01:00 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 Analyst (LPA) Haydee Caliboso met with applicant Mercedes Uriarte today for a pre-licensing inspection. The applicant has requested a combination of an infant with toddler component program. The infant/toddler program will be part of a combination center as the applicant has also applied for a preschool license for 20 children (ages three years old to entry into Kindergarten) at the same location. The applicant has requested 6 infants, ages birth to 18 months, and 16 toddlers, ages 18 months to 36 months. The facility plans to operate Monday - Friday; 8:00 AM to 5:30 PM. The designated Site Supervisor for the facility will be Mercedes Uriarte. The facility was inspected today, indoor and outdoor, for health and safety hazards, and was measured to calculate capacity. This inspection included a technical assistance inspection for COVID-19 guidance and support. Indoor: The facility building that will be used for the program is on the lower level of a residential building. The facility building has its own designated entrance and is gated with a steel fence approximately 10 feet fall. There is one designated classroom for the infant program and two classrooms for the toddler program. The Infant classroom was calculated to be a total of 304.5 sq. ft., allowing for a capacity of 6 infants. Toddler classroom #1 was calculated to be 463 sq. ft., allowing for a capacity of 8 toddlers. Toddler classroom #2 was calculated to be 398 sq. ft., allowing for a capacity of 8 toddlers. The classrooms are observed today to be clean and equipped with a fire extinguisher, and both smoke and carbon monoxide detectors. Cont. 809-C pg. 2

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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: MISSION HEAD START- LA FENIX AT 1950(INF)	FACILITY NUMBER: 384004392
	VISIT DATE: 05/21/2021

NARRATIVE

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The facility is adequately ventilated and free of insects and bugs. The classroom and furniture equipment are clean and in good condition. Children’s toys and supplies are orderly, in good condition, and age appropriate. There is storage space for children's personal belongings. Each classroom has a kitchen with a built-in counter-top area, sinks available for staff and children to use, and garbage cans with tight-fitting lids. The facility has a first aid kit in each classroom and a designated backpack with emergency supplies.

Refrigerated medications will be stored separately from food. Medication will be administered with parental consent and will be kept in the child’s file for record. All medication will be logged when administered to children. The facility has a designated kitchen area where food is prepared, a working refrigerator, and a working dishwasher where utensils are to be cleaned. The program will provide morning and afternoon snacks, and lunch daily. The program will provide a sheet and blanket for the children. Bedding is to be washed twice per week or as needed. Cots will be used for older infants and will be cleaned daily or as needed. Each of the toddler’s classrooms have one toilet and one sink available for children to use, and a diaper changing table within arm’s reach of a sink. The bathrooms were observed to be clean and with no health or safety hazards.

Infant: There is storage for infants’ personal belongings. The program will provide diapers and wipes for the infant. The program will also provide bottles/nipples and any other food service items for each infant, and the staff will ensure breastmilk and or milk formula is served fresh daily to the infant. The infant classroom has a built-in counter-top area, with a sink which includes bottle warmers and a refrigerator. The bottle warmer is out of reach of the children. There are 6 cribs available for infant to use. Drinking water for the children will be provided by plastic baby water bottles or cups with lids provided by the program. Medications for infants will be stored in the classroom in high cabinets or in locked boxes in the refrigerator. All furnishings and equipment are observed to be safe, in good condition, and age appropriate. The diaper changing table area has a sink within arm’s reach. Staff will meet and review the individual written needs and service plans quarterly with the parents. Plans will be kept in the children’s files.
Cont. 809-C pg. 3

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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: MISSION HEAD START- LA FENIX AT 1950(INF)	FACILITY NUMBER: 384004392
	VISIT DATE: 05/21/2021

NARRATIVE

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There is a separate bathroom available for staff to use. The isolation area for ill children is located at the site supervisor’s office. Staff bathrooms will be used for ill children, if needed, until parents arrive for pick-up. Children in the program will be signed in and out daily by parents using an electronic signature. The facility will conduct and log fire drills once every six months, and the log will be available upon request. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children.

Outdoor: The outdoor area measures a total of 2,924 sq. ft., allowing for a total of 38 children. There are three separate outdoor spaces for the preschool, infant, and toddler children. The infant outdoor area was calculated to be 449 sq. ft., allowing for a capacity of 6 infants. The toddler outdoor area was calculated to be 968 sq. ft., allowing for a capacity of 12 toddler children. The program provided a request waiver for the toddler program for scheduled outdoor rotation usage. The facility’s outdoor playground is enclosed and gated with a fence approximately 4 ft. tall. The outdoor space was observed to be clean, safe, and equipped with toys that are age-appropriate for children. The outdoor space playground has pea gravel for cushion. The program has obtained a letter from the landlord for exclusive use of the outdoor space during the hours of care.

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 positive discipline. Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Safe Sleep and Individual Infant Sleeping Plan (LIC 9227), Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements were reviewed today.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. 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

An electronic copy of this three-page report was emailed to Mercedes Uriarte and Theresa Sanchez. Applicants were asked to review the report and return a signed copy of the report to LPA Haydee Caliboso.

Based on available square footage, sinks, and toilets, LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 22 children. The following is required prior to licensure:

· Obtain fire clearance from SF Fire Department.
· COVID-19 Self-Assessment Guide
· Letter of waiver for Toddler component scheduled outdoor rotation
· Letter of approval from the Landlord for exclusive use of outdoor space

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

LIC809 (FAS) - (06/04)

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