414004154-10-22-2024-05-CC-DALO-DAARQB-20241022131317

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004154
Report Date: 10/22/2024
Date Signed: 10/22/2024 01:13:32 PM

Document Has Been Signed on 10/22/2024 01:13 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SSFUSD HILLSIDE CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	414004154
ADMINISTRATOR:	HAGER SULIMAN		FACILITY TYPE:	850
ADDRESS:	1400 HILLSIDE BOULEVARD		TELEPHONE:	(650) 827-8412
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	72	CENSUS: 9	DATE:	10/22/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Hager Suliman		TIME COMPLETED:	01:25 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	On 10/22/2024, at approximately 8:35AM, Licensing Program Analyst (LPAs) Alvarado and Tse conducted an unannounced annual visit at the facility. LPAs met with the Facility Designee, Eric Claybon, and explained the purpose of the visit. Present during the visit was Eric and the Facility Director Hager Suliman who accompanied us upon inspection. Present also are two staff members supervising 9 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 7:30AM to 4:00PM Monday-Friday. LPAs and Director Hager Suliman inspected the facility for any health or safety hazards. LPAs observed the facility to be in clean and orderly condition. The facility is equipped with a fully charged 2A10BC fire extinguishers that is located in the classroom. Fire Alarms and Carbon Monoxide are also posted in all the classrooms. Evacuation routes are posted and accessible for review. There are three classrooms in the facility: Classroom 20, 24, and 25. Currently the Facility is operating in one classroom which is Classroom 20. LPAs observed the surface of all classroom floors to be clean. There are age-appropriate toys and learning materials available. Furniture was observed to be age-appropriate and free of rough or sharp edges. Children nap on cots that are cleaned daily. Bedding sheets are brought from home and taken back once a week for washing on Fridays. Food services for Breakfast, Lunch and Snack are provided by the South San Francisco School District. Facility has two restrooms for children in care, that provides age-appropriate toilets and sinks. 4 toilets, 3 urinals, and 5 sinks fully working. Continued on Page 2..

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SSFUSD HILLSIDE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004154
	VISIT DATE: 10/22/2024

NARRATIVE

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LPAs observed the outdoor play areas to be free of debris and other loose materials. There are age-appropriate toys and equipment available for children to use. Play structures are age-appropriate and cushioned with material that absorbs falls. Outdoor play areas are enclosed by fences. There are no swimming pools or other similar bodies of water present in the facility.

LPAs reviewed four staff files, ten children’s files, and facility records. LPAs observed there to be at least two staff members with current Pediatric First Aid/CPR training. All staff members have current immunization records available for review. All children’s files were observed to be complete. All required postings were observed to be posted and accessible for review upon entry to the facility.

LPAs received an Emergency Drill Schedule, Plan form for the SSFUSD 2024-205, and a copy of an email sent to a lead testing lab. Based on record review, LPAs confirmed that lead testing results were not posted to the lead water database. The facility provided proof that facility's fixtures were sampled on 12/4/2021. LPAs advised that a deficiency would be cited today for lead water testing. Copies of PIN-21-21_1-CCP, LIC9275, and LIC9276 were provided via email.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SSFUSD HILLSIDE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004154
	VISIT DATE: 10/22/2024

NARRATIVE

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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Type B citation has been issued today, October 22, 2024, in accordance with California Code of Regulations, Title 22. Please see the attached LIC809-D.

A plan of correction of this report, appeal rights, and notice of site visit were discussed and provided to Director Hager Suliman . Director was reminded that a Notice of Site visit (LIC 9213) must be posted for 30 consecutive days during the hours of operation after each site visit by a licensing representative Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with the facility representative, Hager Suliman.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/22/2024 01:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SSFUSD HILLSIDE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004154
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not conducting Lead Testing according to the written directives specified in PIN 21-21_1-CCP which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/22/2024
	Plan of Correction
1 2 3 4	Licensee shall reach out to the lab they tested with to upload their initial results, if not fixtures will need to be tested again.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 730-4140
LICENSING EVALUATOR NAME: Diana Alvarado	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC809 (FAS) - (06/04)

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