384004481-9-27-2021-05-CC-GASL-C79SG6-20210927135126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004481
Report Date: 09/27/2021
Date Signed: 09/27/2021 01:51:37 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:	L'ACADEMY PRESCHOOL SF-HAYES VALLEY		FACILITY NUMBER:	384004481
ADMINISTRATOR:	FENG, DANNI		FACILITY TYPE:	830
ADDRESS:	49 PAGE STREET		TELEPHONE:	(415) 658-7817
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94105
CAPACITY:	24	CENSUS: 9	DATE:	09/27/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Helena Geng and Danni Feng		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) Glenn Schnell met with applicant Helena Geng and Director Danni today for a pre-licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is requesting 16 infants (ages birth to two years old). The infant program will be part of a combination center as the applicant has an existing preschool license for 74 children (ages two years old to entry into first grade). The applicant has also submitted an application to reduce the capacity of the preschool due to the addition of the infant program. The infant center plans to operate Monday - Friday; 8:30 AM to 5:30 PM. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. Indoor Infants: The applicant has converted the Lily Room into the Infant Center. The total square footage of the Lily Room is 721.72 Square feet. There is a crib/nap area in back of the room and the square footage of this area is 165.521 square feet- this is encumbered space that will not count in the total square footage. The total useable space for the program will be 556.199 square feet divided by 35 equals 16 infants.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

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: L'ACADEMY PRESCHOOL SF-HAYES VALLEY	FACILITY NUMBER: 384004481
	VISIT DATE: 09/27/2021

NARRATIVE

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The classroom is observed today to be clean and equipped with fire extinguisher, smoke and carbon monoxide detectors, cubbies for infants personal belongings, a crib area with cribs, cots for older infants, at least one changing table per room within arms reach of a sink, and age appropriate toys and equipment for infants. The program primarily plans to serve infants over the age of 12 months old and who are no longer in need of a crib for napping. At this time, the program will have three cribs available for when children enrolled still require the use of a crib. Applicant was reminded that emergency exits must be clear at all times and cots and cribs shall not be placed in a manner that blocks emergency exits. There is storage for infants personal belongings, bedding and other items provided by the parents for the care of individual infants. Parents will provide disposable diapers and wipes for their infants. There is a refrigerator in the infant room for food/drink and medication storage, but any food preparation will occur in the kitchen located in the facility, since there is not a separate food preparation area and sink located directly in the classroom. Food is provided by the parents. Foods will be properly labeled with the child's name and date. Once infants begin to transition to table food, the program will provide the snack. The kitchen has a refrigerator/freezer, sink, microwave, and storage for dry foods. Applicant was reminded that cleaning products and other chemicals are not to be stored with foods. During COVID-19, the facility will use any disposable plates, cups and utensils when necessary. Parents will provide bottles/nipples and any other food service items for their own individual infants and the staff will ensure these items are sent home with the infants each day.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

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: L'ACADEMY PRESCHOOL SF-HAYES VALLEY	FACILITY NUMBER: 384004481
	VISIT DATE: 09/27/2021

NARRATIVE

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Napping equipment for older infant children developmentally too old for a crib will be a cot with proper linens and linens will be provided by parents. The napping equipment and linens will be laundered daily. Drinking water for the children will be provided by plastic baby water bottles or cups with lids provided by the parents. Medications for infants will be stored in the classroom in high cabinets or in locked boxes in the refrigerator. The diaper changing area and sink cannot be used for food preparation or as a counter to store classroom activities or teacher resources. All furnishing and equipment is observed to be safe and in good condition. Applicant will remove all items on top of the cabinets and half wall that separates the Lily Room from the other classroom. There are garbage cans with tight fitting lids. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, first aid and emergency supplies. There is one sink in the infant classroom for children's usage. There are 3 toilets and additional sinks that are located in the preschool bathroom and this bathroom will be used if children in the infant program will begin potty training. All sinks accessible to children deliver water no warmer than 120 degrees. There is a separate bathroom for staff. The isolation room for ill infant will be in the office in the front of the building.
Outdoor Infants: The facility has no outdoor play area and has previously been issued an open space playground waiver permit by San Francisco Recreation and Parks to use the children's play Area at Koshland Park located on Page and Buchanan Streets which is approximately three blocks from the facility. This same waiver will apply to this infant program. Staff will also take infants on daily walks in the community using strollers for younger infants.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

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: L'ACADEMY PRESCHOOL SF-HAYES VALLEY	FACILITY NUMBER: 384004481
	VISIT DATE: 09/27/2021

NARRATIVE

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The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, maintaining and updating needs and service plans for infants, Care and Supervision of the Children, Child Discipline Procedures- talking and redirection will be used, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements (Safe Sleep and SIDS discussed), Completion of Individual Infant Sleeping Plans and supervision of napping infants, Food Service for Infants, Transportation-none provided, Parents Rights, and Reporting Requirements. Applicant will ensure all require postings are displayed and visible to children’s authorized representatives at all times. The requirement for the testing of lead in the water was discussed (H&S Code 1597.16). LPA informed the director/applicant 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.

The facility will conduct monthly disaster drills and a log will be maintained for review upon request. Per the applicant, the fire inspection will be conducted on 10/1/21.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

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: L'ACADEMY PRESCHOOL SF-HAYES VALLEY	FACILITY NUMBER: 384004481
	VISIT DATE: 09/27/2021

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LPA Schnell will recommend licensure of this infant program for a capacity of 16 children once the following is received:
-Approved Fire Safety Clearance for the requested capacity of 16
-Proof that the nap area is completely separate from the activity area with a four foot wall and door that has also been approved by the fire inspector.
-Proof that the entry way to the Infant's bathroom shared with the preschool has been gated and that this has been approved by the local fire inspector.
-Proof that the diaper changing table and pad and the underneath of the pad had been cleaned.
-Proof that cabinet tops and all tops are free and clear of stored items that could fall into children's activity areas.
-Obtain an updated first aid book for the first aid kit
-Obtain a lock box ,for medications, for the refrigerator located in the activity space.
-Clean and organize the storage closet located in the infant room.
-Proof that Danni has completed EMSA certified Lead Poison Training

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

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: L'ACADEMY PRESCHOOL SF-HAYES VALLEY	FACILITY NUMBER: 384004481
	VISIT DATE: 09/27/2021

NARRATIVE

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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

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 Director/Applicant, Helena Geng. Today’s report, 9/27/21, will be sent to Helena Geng at helena@lacademy.co by close of business, 9/27/21. Confirmation of receipt is required.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

LIC809 (FAS) - (06/04)

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