380500491-3-19-2024-05-CC-JTSE-D3HQ2C-20240319114654

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380500491
Report Date: 03/19/2024
Date Signed: 03/19/2024 11:47:08 AM

Document Has Been Signed on 03/19/2024 11:47 AM - 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:	PACIFIC PRIMARY		FACILITY NUMBER:	380500491
ADMINISTRATOR:	TURNER, LYNN R		FACILITY TYPE:	850
ADDRESS:	1500 GROVE STREET		TELEPHONE:	(415) 346-0906
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94117
CAPACITY: 80	TOTAL ENROLLED CHILDREN: 79	CENSUS: 70	DATE:	03/19/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Executive Director, Ilsa Miller		TIME COMPLETED:	12:00 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	On 3/19/2024, at approximately 9:00AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Executive Director Ilsa Miller (D1). LPA explained the purpose of the visit. Present during the visit was the Director, eighteen staff members, and 70 preschool age children. The facility is operating within capacity and staffing ratio requirements on this day. 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 carbon monoxide detectors and fully charged fire extinguishers. There are four classrooms: Rainbow Dolphins, Coyotes, Gray Whales, and Sandpiper. LPA observed all four classrooms to be equipped with age-appropriate toys and learning materials. All trash cans are fitted with tight-fitting lids. Water is provided from filters that are filled from the kitchen sink. Children bring water bottles from home that are filled and available for children to use. Children’s allergies are posted and available for review by staff. All medications are stored out of reach of children in care. First aid kits are present in each classroom and were observed to be complete. There are mats available for children to nap on. Children bring bedding from home and take it back once a week for cleaning. LPA observed a loft to be present in the Sandpiper classroom that has railings secured so that children are not able to climb off or over. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children. LPA observed the outdoor play area to be free of debris and other loose materials. There are age-appropriate play structures present that have resilient padding in the form of sand. LPA observed two first aid kit stations in the outdoor play area. Children’s water bottles are brought outside so that they are accessible during outdoor play. Children have access to toys and play equipment, in addition to an outdoor art station. There are no pools or other bodies of water present in the facility. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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: PACIFIC PRIMARY	FACILITY NUMBER: 380500491
	VISIT DATE: 03/19/2024

NARRATIVE

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LPA reviewed six staff files and five children’s files. LPA observed all staff files to be complete. All staff reviewed were fully qualified teachers. There is at least one staff member with current First Aid/CPR training that expires 8/2025. Mandated Reporter Training is current and maintained in each file. LPA observed all children’s files to be complete.

Children are provided with breakfast, lunch, and an afternoon snack. There are no poisons, cleaning detergents, or other chemicals stored with food in the kitchen.

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 a twww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

D1 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 verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. The facility is currently awaiting lead testing results to be uploaded to the Lead Sampling Database. Test results were provided to LPA, and LPA confirmed that there are no exceedances in all tested fixtures.
Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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

FACILITY NAME: PACIFIC PRIMARY	FACILITY NUMBER: 380500491
	VISIT DATE: 03/19/2024

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/.

D1 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.

No deficiencies were cited during today’s visit on 3/19/2024.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Executive Director, Ilsa Miller.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC809 (FAS) - (06/04)

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