380505534-5-16-2024-05-CC-LGOZ-D5BSMA-20240516135936

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505534
Report Date: 05/16/2024
Date Signed: 05/16/2024 01:59:53 PM

Document Has Been Signed on 05/16/2024 01:59 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	FAMILY DEVELOPMENTAL CENTER (INFANT)		FACILITY NUMBER:	380505534
ADMINISTRATOR/ DIRECTOR:	BELL, EBONY		FACILITY TYPE:	830
ADDRESS:	2730 BRYANT STREET		TELEPHONE:	(415) 282-1090
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 95	TOTAL ENROLLED CHILDREN: 95	CENSUS: 49	DATE:	05/16/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Sophia Adler, Dee Lee, Olabisi Adesuyi-Fasuyi		TIME VISIT/ INSPECTION COMPLETED:	02:10 PM

NARRATIVE

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On 5/16/2024 at 8:45AM., Licensing Program Analyst, (LPA) Luis Gomez met with Site Supervisor, Sophia Adler. The purpose of today’s inspection was explained and is for an Unannounced, Annual Random inspection. The site is a combination center, operating an infant/ toddler and preschool program on-site. Present was the site supervisor and 22 staff supervising 49 children. The Infant/ Toddler program utilizes six classrooms: Stars, 18- 36 months; Butterfly, 18- 36 months; Little Bear, 18- 36 months; Rainbow 0- 24 months; Lady Bugs, 0 -24 months; Caterpillars, 0 – 24 months and the shared, outdoor play yard. Outdoor space waiver for rotational use of play yard was observed posted in lobby. The days and hours of operation are Monday- Friday, 7:30AM- 4:30PM. Classrooms operates year-round. LPA inspected facility for health and safety hazards.

At 9:00AM., LPA observed the following: Infant/ toddler classrooms were clean, orderly, with age-appropriate materials available for the children. The floors and ground surfaces were free of obstructions or possible hazards. Accessible furniture, toys, and playthings inspected were in proper repair. LPA reminded site supervisor to ensure all edges and corners of furniture are rounded. Changing tables were available for staff. Per Site Supervisor, area is disinfected by staff after each use.

LPA reminded director to ensure all tables used for changing children's diapers are located within arm's reach of a sink. Advisory Note: Technical Violation (LIC9102TV) was issued.

Classrooms were equipped with several storage cubbies for children’s belongings. LPA observed feeding chairs available with broad- based legs. For nap services, LPA observed napping area located separately from activity areas. The cribs inspected had visibility on all sides, and properly sized mattresses and sheets. Facility has several stackable cots, made of a cleanable plastic material. Per Site Supervisor, napping sheets and beddings are washed on-site weekly. Classrooms were a comfortable temperature, with ventilation and lighting. Trash bins used for solid waste had been properly covered. Electrical outlets have safety covers installed. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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 05/16/2024 01:59 PM - It Cannot Be Edited

Created By: Luis Gomez On 05/16/2024 at 12:34 PM

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: FAMILY DEVELOPMENTAL CENTER (INFANT)	FACILITY NUMBER: 380505534
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 11:42AM., Based on Record Review, LPA confirmed water testing for lead contamination levels was conducted after the 1/1/2023 deadline. This poses a potential health and safety risk to children in care.
	POC Due Date: 05/23/2024
	Plan of Correction
1 2 3 4	Facility water outlets used for food preparation have been tested. Results show no exceedance of lead. Facility will submit LIC999, Facility Sketch and complementary lead results at a later date.

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: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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: FAMILY DEVELOPMENTAL CENTER (INFANT)	FACILITY NUMBER: 380505534
	VISIT DATE: 05/16/2024

NARRATIVE

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(Page 2)
At 9:57AM., Based on interview and record review, LPA confirmed toddler groupings are exceeding required limit of 12. Advisory Note: Technical Violation (LIC9102TV) was issued.

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) located in hallway.

LPA reviewed classroom food preparation/ storage areas. The food preparation/ storage areas were observed clean and free of rubbish or trash. The infant bottles, formula, and feeding supplies had been correctly stored and labeled. Per Site Supervisor, bottles of milk are made by the staff daily. Feeding bottles are cleaned and sterilized using a soaking procedure.

At 10:20AM., LPA inspected the outdoor play area. Area is completely enclosed with rubber padding installed for added safety. Outdoor play area was clean and free of debris or any hazardous plants. Outdoor playthings were in good repair.

At 10:25AM., Based on observations, record review and interview, LPA confirmed commingling between the toddler option and infant program during scheduled outside play.

For water services, refillable pitcher and cups were available inside and outside, for children to drink as they wish.

At 11:40AM., LPA reviewed facility records including 4 children’s files and 7 personnel files.
At 11:42AM., Based on Record Review, LPA confirmed water testing for lead contamination levels was conducted after the 1/1/2023 deadline.(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

Page: 8 of 8

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: FAMILY DEVELOPMENTAL CENTER (INFANT)	FACILITY NUMBER: 380505534
	VISIT DATE: 05/16/2024

NARRATIVE

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(Page 3)
Facility's staff files were reviewed and included the: Teacher's Qualifications; Personnel Record (LIC701); Proof of Required Immunization; and Mandated Reporter Training (AB1207) certificates.

Facility's children’s files were reviewed and included the: Infant Needs and Services Plan, Consent for Medical Treatment; Identification of Emergency Information; Individual Sleeping Plans (LIC9227) for qualifying infants; and Admissions Agreement. LPA reminded facility to ensure immunization records are stored in facility records.

LPA confirmed staff are documenting infant napping conditions during each 15-minute review.

Facility is conducted required emergency disaster drills every six months, with last drill (Fire Drill) completed on: 4/25/2024.

Present staff member’s cardiopulmonary resuscitation / first aid certification (CPR) was current, expiring: 4/2025.

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

The snack/lunch menu, one week in advance, are posted inside the classrooms.

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

Site Supervisor 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. (REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

Page: 7 of 8

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: FAMILY DEVELOPMENTAL CENTER (INFANT)	FACILITY NUMBER: 380505534
	VISIT DATE: 05/16/2024

NARRATIVE

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(Page 4)
LPA referred Director to the Department website regarding Lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

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.

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 Site Supervisor, Sophia Adler. 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: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

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