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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004405
Report Date: 11/19/2021
Date Signed: 11/19/2021 12:34:30 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:SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOLFACILITY NUMBER:
384004405
ADMINISTRATOR:NANCY LAMBERT-CAMPBELLFACILITY TYPE:
850
ADDRESS:2110 GREENWICH STREETTELEPHONE:
(415) 749-3551
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94123
CAPACITY:96CENSUS: 0DATE:
11/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kristy Ouyang, Nancy Lambert-CampbellTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Glenn Schnell met with San Francisco Unified School District (SFUSD)/facility representative Kristy Ouyang and School Principal/Director Nancy Lambert-Campbell today for a pre-licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is requesting 96 children (ages 2 years to entry into first grade). The program is a Title 5 funded program operated by the School District. The facility will operate Monday - Friday; 7:30 AM to 5:30 PM. The designated director/site supervisor for the facility is Nancy Lambert-Campbell. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: There are four classrooms that will be used for the program and the following square footage was calculated for each room: Room B1, B2, B3, B4; each room is 897 sq ft. Total useable indoor square footage is 3588 sq ft divided by 35 sq ft equals 124 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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: SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL
FACILITY NUMBER: 384004405
VISIT DATE: 11/19/2021
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There is storage space for children's personal belongings and cots to be utilized for napping children. Parents will provide a sheet and blanket for their child, bedding will sent home to be laundered weekly. Cots will be cleaned at least weekly or more often if needed. Children will be signed in and out by manually. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors. Lunch and snacks are provided by the program and children will be taken to the school cafeteria for these periods of the day. Food is prepared at another district location and brought to the school. Foods that will be stored on-site will be strored separately away from cleaning products and other hazards. The kitchen has a dishwasher, sinks, a warming unit and a washing machine. The classrooms have garbage cans with tight-fitting lids and first aid kits. The facility is adequately ventilated and free of insects and bugs. Only disposable products will be used for food service since the facility is not set up to provide adequate sanitization of dishes and utensils.

Medications will be stored in the classrooms in high cabinets inaccessible to the children; refrigerated medication will be kept in the kitchen of the school cafeteria. There are 8 toilets (120 capacity) and 12 sinks (180 capacity) accessible for children's use. Bathrooms are located either inside the classrooms or in the hallway. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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: SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL
FACILITY NUMBER: 384004405
VISIT DATE: 11/19/2021
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There are drinking fountains in each classroom for children to drink water indoors. All toxins and other hazardous items will be stored in a locked cabinet in the classroom and will be inaccessible to children. Isolation of ill children will be located either in the nurses office in the main builidng and staff bathroom will be used for an ill child.

Outdoor: The outdoor area measures 9349 sq ft. allowing for a total of 124 children. The outdoor area to be used is enclosed by at least a four foot fence and observed to be clean, safe and equipped with toys and equipment for children. Resilient material located under climbing applicable climbing structures is a soft padding. To allow children access to drinking water outside, children will have their own water bottles and there are filtered water stations accessible to children to use. Shade for children will be provided by shade structures.

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 talk with the children and use redirection, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation-none provided, 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.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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: SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL
FACILITY NUMBER: 384004405
VISIT DATE: 11/19/2021
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The requirement for the testing of lead in the water was discussed (H&S Code 1597.16). LPA informed the director/licensee to review Provider Information Notice 21-21-CCP (dated 7/28/21) for directives and regulations regarding obtaining a test of the water for lead, and how that information is to be documented and reported to Community Care Licensing. Advisory Note provided to applicants stating that the requirement for testing must be met by January 2023.

Facility representative Ouyang was reminded that all staff who have valid child care permits issued by the Commission of Teacher Credentialing must be fingerprint cleared as part of their employment with the school district under the Department of Education. Other non-permitted staff must obtain appropriate fingerprint clearances through the Department of Social Services Community Care Licensing Division.

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

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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: SFUSD-TULE ELK PARK EARLY EDUCATION SCHOOL
FACILITY NUMBER: 384004405
VISIT DATE: 11/19/2021
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LPA Schnell reviewed the COVID-19 self assessment guide and required postings with the applicant today. Applicant was informed that access to available Personal Protective Equipment (PPE) may be available through the local child care resource and referral agency.

Report was reviewed and signed by Facility Representative, Kristy Ouyang. Today’s report, 11/19/21, will be sent to Kristy Ouyang at kouyang@sfusd.edu by close of business, 11/19/21. Confirmation of receipt is required.

LPA Schnell will recommend licensure of this facility for a capacity of 96 children once the following is received:
-Approved Fire Clearance for 96 children
-Pictures showing the rooms and the outdoor space set up and ready for use
-Timeline for completion of remaining construction
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
LIC809 (FAS) - (06/04)
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