380500099-5-28-2024-05-CC-JTSE-D5PQCM-20240528120323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380500099
Report Date: 05/28/2024
Date Signed: 05/28/2024 12:03:46 PM

Document Has Been Signed on 05/28/2024 12:03 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:	CALVARY PRESBYTERIAN CHURCH NURSERY SCHOOL		FACILITY NUMBER:	380500099
ADMINISTRATOR:	RAU, STEPHANIE		FACILITY TYPE:	850
ADDRESS:	2515 FILLMORE STREET		TELEPHONE:	(415) 346-4715
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94115
CAPACITY:	75	CENSUS: 48	DATE:	05/28/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Director, Stephanie Rau		TIME COMPLETED:	12:15 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 5/28/2024, at approximately 8:50AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Director Stephanie Rau (D1) and explained the purpose of the visit. Present during the visit were D1, 11 staff members, and 48 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility is a half-day program that runs from 8:30AM to 12:00PM, with after care offered until 3:00PM. The facility is located on the premises of Calvary Presbyterian Church and utilizes the first floor, third floor, and the rooftop playground. LPA inspected the facility for any health or safety hazards. LPA observed the facility to be in clean and orderly condition. The facility is equipped with fully charged fire extinguishers that are at least size 2A10BC. There is a fire alarm system running throughout the building. There are operational smoke and carbon monoxide detectors present. Electrical outlets were observed to be covered or obstructed by furniture when not in use to be inaccessible to children in care. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. The facility is currently operating in four classrooms: Bluebirds, Penguins, Eagles, and Sea Lions. LPA observed age-appropriate toys and learning materials to be present in each classroom. Children have access to manipulatives and art supplies for activities. Furniture is age-appropriate and free of rough or sharp edges. Children bring water bottles from home and refill them from a water dispenser. The facility receives water services twice a month. LPA observed that waste bins in classrooms did not have tight-fitting lids. LPA advised that all waste bins that store solid waste shall have tight-fitting lids. D1 stated that they understood. See LIC9102-TV for technical violation issued today. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024

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: CALVARY PRESBYTERIAN CHURCH NURSERY SCHOOL	FACILITY NUMBER: 380500099
	VISIT DATE: 05/28/2024

NARRATIVE

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The facility uses an outdoor play area that is situated on the roof of the building. There is fencing that completely encloses the outdoor play area to ensure that children do not have access to the edges of the rooftop. Gates within the fencing are secured by padlocks. There is a play structure present that is cushioned with resilient padding. LPA observed that the play structure is intended for use by children from the ages of 5 to 12. LPA advised that the facility shall ensure that only the appropriate age groups use the play structure. D1 stated that they understood. There is a gravel pit in the outdoor play area. There are no pools or other bodies of water present in the facility. Off-limits areas are kept inaccessible to children in care via locks.

LPA reviewed five staff files, six children’s files, and facility records. There is at least one staff with current Pediatric First Aid/CPR training. All teacher files reviewed have appropriate qualifications and immunization records available for review. LPA advised that all staff shall complete Mandated Reporter Training. D1 stated that they understood. See LIC9102-TV for technical violation issued today. LPA observed all children’s files to be complete. All required postings are posted and accessible for review in the hallway of the facility. The facility last conducted an emergency drill on 5/23/2024. Emergency drills are properly logged and documented.

LPA observed that the facility did not have any lead testing results on record. Based on interview with D1, LPA found that the facility has not conducted lead testing for the outlets in the facility yet. LPA advised that outlets that are used for food preparation or water consumption shall be tested. D1 stated that they understood. See LIC809-D for deficiency cited today.

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.

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024

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: CALVARY PRESBYTERIAN CHURCH NURSERY SCHOOL	FACILITY NUMBER: 380500099
	VISIT DATE: 05/28/2024

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).

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care
Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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.

See LIC809-D for deficiency cited today regarding lead water testing. See LIC9102-TV for technical violations issued today regarding Mandated Reporter Training and tight-fitting lids.
Appeal rights were provided and explained. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Stephanie Rau.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024

LIC809 (FAS) - (06/04)

Page: 3 of 6

Document Has Been Signed on 05/28/2024 12:03 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: CALVARY PRESBYTERIAN CHURCH NURSERY SCHOOL	FACILITY NUMBER: 380500099
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above by not testing its outlets for lead before the deadline of 1/1/2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2024
	Plan of Correction
1 2 3 4	The facility shall test its fixtures for lead by set due date of 6/28/2024 and submit LIC9275, LIC9276, and LIC999 to LPA via email.

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) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024

LIC809 (FAS) - (06/04)

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