380504984-7-3-2024-05-CC-LGOZ-D6TPT6-20240703113525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504984
Report Date: 07/03/2024
Date Signed: 07/03/2024 11:35:38 AM

Document Has Been Signed on 07/03/2024 11:35 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:	KATHERINE MICHIELS SCHOOL		FACILITY NUMBER:	380504984
ADMINISTRATOR/ DIRECTOR:	ANCHETA, YOLANDA		FACILITY TYPE:	830
ADDRESS:	1335 GUERRERO STREET		TELEPHONE:	(415) 821-0130
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 15	CENSUS: 9	DATE:	07/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:25 AM
MET WITH:	Yolanda Ancheta		TIME VISIT/ INSPECTION COMPLETED:	11:50 AM

NARRATIVE

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On 7/3/2024 at 8:25AM., Licensing Program Analyst, (LPA) Luis Gomez met with Director, Yolanda Ancheta. The purpose of today’s inspection was explained and is for an Unannounced, Annual Random inspection. This site is a licensed infant combination center, with a preschool program on-site. Present was the Director and 6 staff supervising 9 children. Staff have criminal record clearances on file. The infant program utilizes one classroom: Peach Palace (0- 24 months) and the shared, outdoor play area. The days and hours of operation are Monday- Friday, 8:00AM- 6:00PM. Infant classroom operates year-round. LPA inspected facility for health and safety hazards.

At 8:35AM., LPA observed the following: facility was clean and neat, with adequate materials available. Floors and ground surfaces were free of obstructions or possible hazards. Off-limit area have been made in accessed with child installed safety gates and doors. Accessible furniture, toys (cleanable), and age-appropriate playthings inspected were in proper repair. LPA observed changing table available for staff, within arm's reach of a sink. Per director, area is disinfected by staff after use. Facility is equipped with cubbies and hangers for children’s belongings. LPA observed several feeding chairs and table with rounded edges.

LPA advised director to ensure all feeding chairs used for food services are broad- based.

For nap services, LPA observed cribs available in napping room, with tight-fitting sheet and mattress. The cribs inspected had visibility on all sides. Facility has several stackable cots, made of a cleanable plastic material. Per Director, napping sheets and bedding is washed on-site weekly.

Facility was a comfortable temperature, with lighting and ventilation. Trash bins used for disposal of solid waste have been covered. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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 07/03/2024 11:35 AM - It Cannot Be Edited

Created By: Luis Gomez On 07/03/2024 at 11:01 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: KATHERINE MICHIELS SCHOOL	FACILITY NUMBER: 380504984
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

(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	At 9:40AM., Based on record review, LPA confirmed testing for lead contamination level of facility’s drinking water/ food preparation was conducted after the 1/1/2023 deadline. This poses a potential health and safety risk to children in care.
	POC Due Date: 07/04/2024
	Plan of Correction
1 2 3 4	The testing of water outlets have been conducted with no documented lead level exceedance. Deficiency has been cleared.

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:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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: KATHERINE MICHIELS SCHOOL	FACILITY NUMBER: 380504984
	VISIT DATE: 07/03/2024

NARRATIVE

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(Page 2)
The cleaning compounds, detergents, medications, and other items which could pose a danger, have been stored inaccessible to children. Classrooms have smoke detectors (built-in); functioning carbon monoxide detectors; and fully charged fire extinguisher (2A:10BC).

LPA reviewed the food preparation/ storage areas. The food preparation/ storage areas were observed clean, free of rubbish or trash. Infant bottles of milk and lunches are brought by families daily and stored in the refrigerator. LPA observed bottles are properly labeled with the child’s name.

At 9:05AM., LPA inspected the outdoor play area. Area is completely enclosed and free of debris or any hazardous plants. Sand area is reviewed daily by staff, and did not have any foreign objects. Outdoor playthings were in good repair, which shaded rest and water readily available.

At 9:35AM., LPA reviewed facility records including 4 children’s files and 7 personnel files.
At 9:40AM., Based on record review, LPA confirmed testing for lead contamination level of facility’s drinking water/ food preparation was conducted after the 1/1/2023 deadline.

The personnel files were reviewed and included staff’s: Teacher Qualifications; Personnel Record (LIC701); Notice of Employee Rights (LIC9052); and Mandated Reporter Training (AB1207) certificates.

The children's files were reviewed and included: Infant Needs and Services Plan; Notice of Parents Rights (LIC995A); Personal Right (LIC613A); Consent for Medical Treatment; Identification of Emergency Information; Individual Sleeping Plans (LIC9227) for qualifying infants; and Admissions Agreement.

Facility is documenting infant napping conditions during each 15-minute review.

At 10:00AM. Based on record review, LPA confirmed staff not initialing napping logs during each 15-minute review. Advisory Note: Technical Violation (LIC9102TV) was issued. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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: KATHERINE MICHIELS SCHOOL	FACILITY NUMBER: 380504984
	VISIT DATE: 07/03/2024

NARRATIVE

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(PAGE 3)
Present staff member’s cardiopulmonary resuscitation / first aid certification (CPR) was current, expiring: 6/2025.

LPA reminded director to conduct disaster drill ever six months. Advisory Note: Technical Violation (LIC9102TV) was issued.

Required posting were observed in the facility including the: Facility License; Emergency Disaster Plan (LIC610); Earthquake Preparedness Checklist; Seat Beat Safety Laws; Snack Menu; Lead Test Results; and Notification of Parent’s Rights (LIC995A).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Facility was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

LPA discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at: http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.

(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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: KATHERINE MICHIELS SCHOOL	FACILITY NUMBER: 380504984
	VISIT DATE: 07/03/2024

NARRATIVE

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(PAGE 4)
Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12, Chap. 1 Ca. Code of Regulations and cited on 809D. Exit interview, plan for correction and facility evaluation report was discussed with Director, Yolanda Ancheta. The administrator's signature of this form acknowledges receipt of these documents.

This report and rights to comment were discussed. This report must be available in the facility for public review.

Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC809 (FAS) - (06/04)

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