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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380504776
Report Date: 07/02/2024
Date Signed: 07/02/2024 11:43:00 AM

Document Has Been Signed on 07/02/2024 11:43 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:NIHONMACHI LITTLE FRIENDS SUTTER SITEFACILITY NUMBER:
380504776
ADMINISTRATOR/
DIRECTOR:		INAMASU, CATHYFACILITY TYPE:
850
ADDRESS:1830 SUTTER STREETTELEPHONE:
(415) 922-4060
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 91TOTAL ENROLLED CHILDREN: 66CENSUS: 23DATE:
07/02/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Site Supervisor, Naomi MiuraTIME VISIT/
INSPECTION COMPLETED:
11:55 AM
NARRATIVE
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On 7/2/2024, at approximately 10:00AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced case management visit at the facility. LPA met with Site Supervisor, Naomi Miura (D1). Present during the visit was D1, six staff and 23 preschool-age children.

Based on LPA's record review and interview, there was a staff member (S1) present in the facility who was not associated to the facility. LPA discussed fingerprint clearance and association requirements with D1. During the visit, LPA found that S1 did have a valid fingerprint clearance and was able to associate them to the facility. LPA informed D1 that a Type A deficiency shall be cited today, in addition to a civil penalty. D1 stated that they understood.

LPA inspected the outdoor play area of the facility and found that it is equipped with resilient padding and cushioning. LPA observed that the facility uses blocks from Community Playthings. Based on file review of the user guide for the blocks, they are intended for use by children ages three and up. Based on LPA's record review, LPA confirmed that a child under the age of three had access to and was playing with the blocks. The child sustained an injury as a result. LPA informed D1 that a deficiency shall be cited for play equipment not being age-appropriate for children in care. D1 stated that they understood.

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.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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Document Has Been Signed on 07/02/2024 11:43 AM - It Cannot Be Edited


Created By: Jonathan Tse On 07/01/2024 at 10:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NIHONMACHI LITTLE FRIENDS SUTTER SITE
FACILITY NUMBER: 380504776

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2024
Section Cited
HSC
1596.871(c)(1)(A)

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Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification...prior to employment, residence, or initial presence in the facility.
This requirement was not met as evidenced by:
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S1 was associated to the facility on this day, 7/2/2024. LPA discussed fingerprint clearance requirements with D1.
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Based on observation and record review, Licensee did not comply with the above by not ensuring that a staff member (S1) was associated to the facility prior to their presence in the facility. This poses an immediate health, safety, or personal rights risk to persons in care.
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This deficiency shall be cited and cleared on this day, 7/2/2024.
Type A
07/09/2024
Section Cited
CCR101239(m)

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All play equipment and materials used by children shall be age-appropriate.

This requirement was not met as evidenced by:
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Licensee shall conduct a staff training to ensure that children are only allowed access to play equipment and materials that are age-appropriate. Staff training shall include information on appropriate use of Community Playthings building blocks.
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Based on observation, interview, and record review, Licensee did not comply with the above by allowing children under the age of three to use play equipment intended for use by children age three and up. This posed an immediate health, safety, or personal rights risk to persons in care.
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D1 shall submit a meeting memo that is signed by all staff by set due date of 7/9/2024.
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
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


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: NIHONMACHI LITTLE FRIENDS SUTTER SITE
FACILITY NUMBER: 380504776
VISIT DATE: 07/02/2024
NARRATIVE
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Page Two
LPA advised D1 that all facility staff should be familiar with the user guides of toys and equipment intended for use by children. D1 stated that they understood.

LPA Tse informed facility representative Naomi Miura that this report dated 7/2/2024 documents one Type A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Tse informed the facility representative to provide a copy of this licensing report dated 7/2/2024 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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, Naomi Miura.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
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