380505210-3-8-2024-05-CC-BVAN-D36QVA-20240308113002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505210
Report Date: 03/08/2024
Date Signed: 03/08/2024 11:30:11 AM

Document Has Been Signed on 03/08/2024 11:30 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	ULLOA CHILDREN'S CENTER		FACILITY NUMBER:	380505210
ADMINISTRATOR:	WANG, CAILING		FACILITY TYPE:	840
ADDRESS:	2650 42ND AVENUE		TELEPHONE:	(415) 759-8854
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94116
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 38	DATE:	03/08/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Cailing Wang and Timothy Lopez		TIME COMPLETED:	11:25 AM

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 March 8, 2024, Licensing Program Analyst (LPA) Van performed an unannounced mandated annual inspection and met with the 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 operation are Monday to Friday, the morning program from 7:00 am to 9:30 am, and the after-school program from 3:30 pm to 6:30 pm. Upon LPA entrance, there were 12 school-aged children supervised by the Director and the Assistant Director. During the inspection, three teachers and 26 more children arrived. 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. The tutoring room has age-appropriate games, books, and equipment that is in good repair. The room has acceptable ventilation and ample lighting. Each child has a basket to store their belonging. The facility has a dual centralized smoke detector & carbon monoxide detector and multiple fully charged fire extinguishers. The facility has no pools, spas, or other bodies of water. All cleaning solutions, poisons, and other dangerous chemicals are inaccessible to children. LPA observed that the unused electrical outlets have covers installed. All the bathrooms, toilets, and sinks are clean and well-sanitized. All solid waste bins have a suitable tight-fitted lid on top. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

Document Has Been Signed on 03/08/2024 11:30 AM - It Cannot Be Edited

Created By: Brendon Van On 03/08/2024 at 10:07 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: ULLOA CHILDREN'S CENTER	FACILITY NUMBER: 380505210
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)(8)(C)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: (C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the record review, the Center did not comply with the abovementioned section. Three out of ten children were missing Consent for Emergency Treatment form LIC 627, which poses/posed a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 03/22/2024
	Plan of Correction
1 2 3 4	The Center Director must ensure all children's Consent for Emergency Treatment forms are on file. The Center will provide the forms to the parents and send a copy of completion to LPA by March 22.

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:

Garfield Leung

LICENSING EVALUATOR NAME:

Brendon Van

LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ULLOA CHILDREN'S CENTER	FACILITY NUMBER: 380505210
	VISIT DATE: 03/08/2024

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
26
27
28
29
30
31
32

The outdoor playground area is in good repair and completely fenced for supervision. The play structure is age-appropriate and in good condition, with soft rubber cushioning underneath for accidental falls.

Per the Assistant Director, the after-school program starts at 3:30 pm. The Center will have dedicated staff to pick up the kindergarteners and first graders from their respective classrooms and escort them to the program. The older children will be accompanied to the program by their classroom teachers. The staff will sign in all children, and a headcount will be taken before entering the classroom to ensure everyone's safety.

LPA reviewed ten children's and five staff records. Most records of the children were found to be complete, including their names, addresses, and authorized representative telephone numbers. However, LPA noticed three out of ten children did not have the Consent for Emergency Consent form, LIC 627. Staff members' records showed that all individuals requiring caregiver background checks had undergone criminal records and child abuse index clearances or exemptions. Several teachers possess valid CPR certificates. LPA reviewed the educational qualifications of the staff members and confirmed that everyone had completed the required ECE units and mandated reporter training.

LPA observed that the facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, and Notification of Personal Rights). The Assistant Director stated that Fire and Earthquake drills are conducted monthly; the last drills were conducted on 2/6/2024.

The Assistant Director 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.
Continued on page 3...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ULLOA CHILDREN'S CENTER	FACILITY NUMBER: 380505210
	VISIT DATE: 03/08/2024

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
26
27
28
29
30
31
32

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The Assistant Director was informed about Mandated Reporter training AB 1207. The Mandated Reporter AB 1207 training must be completed every two years by the Licensee and for all staff hired. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

The Assistant Director was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain child care by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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 childcare 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).

Continued on page 4...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ULLOA CHILDREN'S CENTER	FACILITY NUMBER: 380505210
	VISIT DATE: 03/08/2024

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
26
27
28
29
30
31
32

The Center has a written attestation approved on October 24, 2023. The written attestation indicated that the Center has no water outlets used or made accessible to children to use for food preparation or drinking water and, therefore, is not required to test any water outlets per Health and Safety Code 1597.16 at this time. The Center provides water bottles to children indoors and outdoors. Per the Assistant Director, the Center purchases cases of individual water bottles directly from the grocery store. LPA observed five cases of 24 bottles stored in the staff lounge available for children.

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

See LIC 809D for deficiency cited during the inspection.

During the inspection, LPA requested the following document to be sent to the Licensing office by June 30:
· Personnel report LIC 500
· Emergency Disaster Plan LIC 600

The Assistant Director was given a notice of site visit and appeal rights. LPA informed that the notice must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

An exit interview was conducted, and the report was reviewed with the Assistant Director, Timothy Lopez.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

Page: 5 of 5