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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002881
Report Date: 07/07/2022
Date Signed: 07/07/2022 12:37:41 PM


Document Has Been Signed on 07/07/2022 12:37 PM - It Cannot Be Edited

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:PFS-BAYSHORE MISSION STREET CDC (INFANT)FACILITY NUMBER:
414002881
ADMINISTRATOR:ROSALIE MIJOSFACILITY TYPE:
830
ADDRESS:7222 MISSION STREETTELEPHONE:
(650) 758-0743
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY:23CENSUS: 12DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Rosalie MijosTIME COMPLETED:
11:30 AM
NARRATIVE
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On 07/02/2022 at 8:45 AM., Licensing Program Analyst, Kaur met with Director Rosalie Mijos. Purpose of the inspection was explained and is for an Unannounced Annual/ Random inspection. Present is the director, staff and 12 infants in care. Facility was operating within capacity limits of the license on this day. All staff had their criminal record clearance of file. Infant program utilizes 2 classroom. Hours of operation are Monday- Friday 7:30am - 5:45pm. Program operates year-round. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

LPA observed the following. Infant classrooms were clean, organized with plenty of age-appropriate toy and playthings. Floors and surfaces were free of hazards. Classrooms had been separated into several sections using child separation walls. Classroom areas including: Napping area, Recreation area and Sink area. Classroom had individualized cubbies for storage of children’s belongings. Classrooms had been equipped with diaper changing table, locating was within arm’s reach of a sink. Food preparation areas were made inaccessible to day-care children, and equipped with a refrigerator and cabinets for added storage. LPA observed milk, and food had been properly stored and labeled with children's names. For napping services, each infant had their own crib or cot, available with tight fitting sheet. Infant cribs had visible sides for constant staff supervision. . Classroom had acceptable ventilation and natural lighting.

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
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: PFS-BAYSHORE MISSION STREET CDC (INFANT)
FACILITY NUMBER: 414002881
VISIT DATE: 07/07/2022
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LPA Kaur observed Staff restrooms are in the facility hallway. Detergents, cleaning supplies and sharp objects were made inaccessible. Classroom had a smoke detector, carbon monoxide detector and a fully charged fire extinguisher (2A:60BC) located in the hallway.

At 09:05 AM., LPA inspected infant outdoor play area. LPA observed area had been completely enclosed with tall fencing. Area is equipped with soft padding for added safety. Outdoor play area is kept clean, free of debris or hazardous items. All outdoor equipment was in good repair and properly anchored. For water services, staff provided fresh water with disposable cups.

During inspection, LPA review 6 children’s files and 6 personnel files. Staff files reviewed were complete with current Mandated Reporter Training Certification, Required Immunization, Proof of Education, Notice of Employee Rights (LIC9052) and Criminal Record Statement (LIC508). Present staff members had their current CPR/ 1st aid certification on file which expires: 04/23

Children files were reviewed and included following: Infant Needs and Services Plan, Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700), Updated Immunization Records and Admissions Agreement.

Emergency drills are being conducted at the facility, with last drill completed on, 06/10/22, and was properly logged. Per Director, Program provide all daily snack and meals for day-care children. All required posting were observed in the facility lobby. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
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: PFS-BAYSHORE MISSION STREET CDC (INFANT)
FACILITY NUMBER: 414002881
VISIT DATE: 07/07/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

LPA discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview conducted and report reviewed with Dircetor, Rosalie Mijos and her signature of this form acknowledges receipt of these documents. Todays report will be email to Director at RMIJOS@PENINSULAFAMILYSERVICE.ORG



This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3