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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505210
Report Date: 09/22/2022
Date Signed: 09/22/2022 05:09:16 PM

Document Has Been Signed on 09/22/2022 05:09 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ULLOA CHILDREN'S CENTERFACILITY NUMBER:
380505210
ADMINISTRATOR:WANG, CAILINGFACILITY TYPE:
840
ADDRESS:2650 42ND AVENUETELEPHONE:
(415) 759-8854
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 47DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:CaiLing Wang and Timothy LopezTIME COMPLETED:
05:15 PM
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On September 22, 2022, Program Analyst (LPA) Van performed an unannounced mandated annual inspection and met with the new Director, CaiLing Wang, and Assistant Director, Timothy Lopez. The purpose of the inspection was explained to the Director. This facility is a school-aged after-school program that operates in the SFUSD Ulloa Elementary School. The Ulloa School approved the Center to use the tutoring room, the Gym, boys' and girls' bathrooms, and the outdoor playground. The days and hours of operations are Monday to Friday, the morning program from 7:00 am to 9:30 am the after-school program from 3:30 pm to 6:30 pm. In the morning today, 47 children were supervised by five teachers.

The Assistant Director and LPA inspected the facility for potential health and safety hazards. LPA observed the facility had signed in and out records with complete parents' signatures, and all signatures matched the number of children in care. All classrooms have age-appropriate games, books, and equipment in good repair. Classrooms have acceptable ventilation and ample lighting. The facility has a centralized smoke detector, a fully charged fire extinguisher, and carbon monoxide. There are no pools, spas, or other bodies of water at the facility. All cleaning solutions, poisons, and other dangerous chemicals are stored inaccessible to children. All the bathrooms, toilets, and sinks are clean and well sanitized. All solid waste bins have a suitable tight-fitted lid on top. The facility has multiple water dispensaries and water fountains readily available for children. The outdoor playground area is in good repair and completely fenced for supervision. Per Assistant Director, the play structure for the kindergarten is currently being renovated.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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: ULLOA CHILDREN'S CENTER
FACILITY NUMBER: 380505210
VISIT DATE: 09/22/2022
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In today's inspection, LPA reviewed random samples of children's and staff records. Per Assistant Director, a designated teacher will pick up the Kindergartener and bring them to the program. The older children will walk to the program by themselves. The teacher will sign in all children. All children had a medical assessment, and required licensing forms were completed. All staff has criminal record clearance. Director has a record of Pediatric FirstAid/CPR cards in the file and the required immunization. LPA also observed that the facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, and Notification of Personal Rights). The Director stated that Fire and Earthquake drills are done monthly; the last drills were conducted on 9/1/2022.

The incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

The Director 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 a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA reminded the Director that as of September 1, 2016. A person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles. LPA observed that the facility has a record of required immunization of all staff.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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: ULLOA CHILDREN'S CENTER
FACILITY NUMBER: 380505210
VISIT DATE: 09/22/2022
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The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to complete every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

LPA encouraged the Director to visit the CCLD website at www.ccld.ca.gov for licensing regulations and new updates. The Director can also email at childcareadvocatesprogram@dss.ca.gov and ask for the updates to be added to the email list.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

During the inspection, LPA requested the following document to be sent to LPA by September 30:
1. Designation of Responsibility (LIC 308)
2. Personnel Report (LIC 500)
3. Incidental Medical Services (IMS) Plan
4. Updated Mandated Reporter Training and Basic Pest Management Training

No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Assistant Director, Timothy Lopez. Today's report, September 22, 2022, and notice of site visit were provided to the Director. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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