414004560-6-13-2019-05-CC-PHSH-BD4SL4-20190613135740

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004560
Report Date: 06/12/2019
Date Signed: 06/13/2019 01:57:46 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:	AMIGOS DE SF		FACILITY NUMBER:	414004560
ADMINISTRATOR:	CARNIGLIA, JULIE		FACILITY TYPE:	850
ADDRESS:	1020 SULLIVAN AVENUE		TELEPHONE:	(650) 218-1555
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	25	CENSUS: 0	DATE:	06/12/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Julie Carniglia		TIME COMPLETED:	03:30 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) Pandora Huffman-Smith met with the applicant today for a pre-licensing inspection. This facility is part of a duplex unit located on the lower level. The applicant is requesting a capacity of 25 preschool age children and will operate Monday - Friday from 8:00 AM to 6:00 PM. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. Indoor: The facility measures 784 square feet allowing for a total capacity of 22 children. The facility appears to be clean and equipped with a fire extinguisher, smoke and carbon monoxide detectors, kitchen/food prep area, children's cubbies, toys and equipment for children, and first aid supplies. Emergency supplies will be required to be provided by parents on the first day of enrollment. All furnishing and equipment appear to be safe and in good condition. There is one bathroom for children's usage that is equipped with 2 toilets and 2 sinks. There is an additional sink in the classroom for children's usage. Total capacity allowed for toilets are 30 and for sinks is 45. There is an additional bathroom for staff usage. Drinking water for children will be supplied by the facility, but parents will be required to supply water bottles for their child's usage. The facility will maintain additional water bottles on site. Ill children will be isolated in one of the areas of the facility until parent arrives for pick up and the staff bathroom will be used. All toxins and other hazardous items will be stored in the kitchen which is off limits and inaccessible to children. Outdoor: The outdoor area measures 1096 square feet allowing for a total of 14 children. A waiver will need to be submitted for scheduled rotational usage. The outdoor area appears to be clean, safe and equipped with toys and equipment for children. There is sufficient cushioning underneath the play structure. Continued on page 2

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Pandora Huffman-Smith	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019

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: AMIGOS DE SF	FACILITY NUMBER: 414004560
	VISIT DATE: 06/12/2019

NARRATIVE

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The applicant stated that disaster drills will be conducted at least once every six months and a log will be maintained for review. A fire inspection has been conducted and approved as of May 29, 2019.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area where the medication and equipment/supplies will be stored. 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

A copy of Title 22 Regulation 101173 was given to the applicant.

Requirements prior to licensure:

Request for outdoor waiver.
A plan of operation for incidental medical services is required for all facilities that will administer medication.
Napping mats
copy of sign in and out sheet
Management approval is required

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Pandora Huffman-Smith	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019

LIC809 (FAS) - (06/04)

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