384004393-5-26-2021-05-CC-HRCO-C3E22Z-20210526170133

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004393
Report Date: 05/21/2021
Date Signed: 05/26/2021 05:01:43 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(PS)		FACILITY NUMBER:	384004393
ADMINISTRATOR:	URIARTE, MERCEDES		FACILITY TYPE:	850
ADDRESS:	1954 MISSION ST. STE.A		TELEPHONE:	(415) 206-7752
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94103
CAPACITY:	20	CENSUS: 0	DATE:	05/21/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Mercedes Uriarte		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 Analyst (LPA) Haydee Caliboso met with applicant Mercedes Uriarte today for a pre-licensing inspection. The applicant has requested a combination of preschool program and infant with toddler component program. The preschool program will be part of a combination center as the applicant has also applied for an infant program with toddler component license for 22 children (ages birth to 36 months) at the same location. The applicant has requested 20 preschool children ages 3 to Kindergarten. 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 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. The program has a designated a conference room for children who need additional support during the hours of care. The Conference room was observed to be clean and safe. The Conference room was calculated to be 207 sq. ft. There is one classroom designated for the preschool children. The Preschool classroom was calculated to be 1,029 sq. ft., allowing for a capacity of 20 preschool children. 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, and cots to be utilized for napping children. The program will provide a sheet and blanket for the children. Bedding is to be washed twice per week or as needed. 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(PS)	FACILITY NUMBER: 384004393
	VISIT DATE: 05/21/2021

NARRATIVE

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The classroom is equipped with a fire extinguisher and both smoke and carbon monoxide detectors. The facility is adequately ventilated and free of insects and bugs. The 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 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 preschool classroom has 2 toilets and 2 sinks available for children to use. The restroom is clean and does not have any health or safety hazards. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children. The isolation area for ill children is in the site supervisor office, and staff bathrooms will be used for ill children. There is designated restroom for staff to use. Pitchers of water and disposable cups will be provided for both indoor and outdoor use.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.

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 preschool outdoor area was calculated to be 1,507 sq. ft., allowing for a capacity of 20 children. 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.
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)

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: MISSION HEAD START- LA FENIX AT 1950(PS)	FACILITY NUMBER: 384004393
	VISIT DATE: 05/21/2021

NARRATIVE

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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 and logical consequences. Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements.

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 Theresa Sanchez. Applicant was asked to review the report and return a signed copy of the report to LPA Haydee Caliboso. COVID-19 Self-assessment guide was received and reviewed today with the Director.

Based on available square footage, sinks, and toilets, LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 20 children. The following is required prior to licensure:

· Obtain fire clearance from SF Fire Department.
· 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: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

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