384004406-8-25-2021-05-CC-HRCO-C68T4E-20210825142350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004406
Report Date: 08/24/2021
Date Signed: 08/25/2021 02:24:01 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:	FACESSF-BAYVIEW INFANT		FACILITY NUMBER:	384004406
ADMINISTRATOR:	WONG, KIM		FACILITY TYPE:	830
ADDRESS:	100 WHITNEY CIRCLE		TELEPHONE:	(415) 567-2357
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94124
CAPACITY:	6	CENSUS: 0	DATE:	08/24/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kim Wong & Robyn King		TIME COMPLETED:	12:20 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 the applicants Kim Wong, (Program Director), and Robyn King (Site Supervisor) today for a pre-licensing inspection. The applicant has requested for 6 infants, ages birth to 18 months. The facility plans to operate Monday - Friday; 7:30 AM to 5:30 PM. The designated Site Supervisor for the facility will be Robyn King. 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: There is one designated classroom for the infant program. The infant classroom is in room #5 and is calculated for 339.89 sq. ft., allowing for a capacity of 6 infants. The classrooms are observed today to be clean and 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 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. Cont. 809 -C pg.2

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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 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: FACESSF-BAYVIEW INFANT	FACILITY NUMBER: 384004406
	VISIT DATE: 08/24/2021

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 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. The diaper changing area and indoor classroom 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. There is another sink available for children to use in the classroom. 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.

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 program has requested for the infant program to use the toddler outdoor area. The program provided a request waiver for the infant program for scheduled outdoor rotation usage.
Cont. 809-C pg.3

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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: FACESSF-BAYVIEW INFANT	FACILITY NUMBER: 384004406
	VISIT DATE: 08/24/2021

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 outdoor area was calculated to be 700.745 sq. ft., allowing for a capacity of 6 infants. The infant children will be transported to the outdoor yard using the quad sport stroller through the preschool outdoor. The facility’s outdoor playground is enclosed and gated with a fence approximately 6 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 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 redirection for 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 Kim Wong and Robyn King. The applicants were 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 Robyn King.

Based on available square footage, sinks, and toilets, LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 6 infant children. The following is required prior to licensure:
· A moveable wall sound absorbing at least 4 feet high in placed at sleeping area.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3