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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505568
Report Date: 05/09/2024
Date Signed: 05/09/2024 01:15:48 PM

Document Has Been Signed on 05/09/2024 01:15 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 (PRESCHOOL)FACILITY NUMBER:
380505568
ADMINISTRATOR/
DIRECTOR:		QUIROZ, YOHANAFACILITY TYPE:
850
ADDRESS:2730 BRYANT STREETTELEPHONE:
(415) 282-1090
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 58DATE:
05/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Mindy Camacho, Dee Lee TIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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On 5/9/2024 at 8:45AM., Licensing Program Analyst (LPA), Luis Gomez met with Administrator, Mindy Camacho. The purpose of today's inspection was explained and was for an Unannounced, Annual Random inspection. Facility is preschool, combination center with an infant program on site. Program Director, Dee Lee arrived during inspection. Present were 14 staff supervising 58 children. The preschool program utilizes 4 classrooms: Sunshine; Starfish; Bumble Bees; Blue Birds; and the shared, Outdoor Play Yard. Outdoor space waiver was observed in entry way. LPA inspected this facility for health and safety hazards.

At 9:00AM., LPA observed the following: Classrooms were clean, orderly, with age-appropriate materials available for the children. Walkways and ground surfaces were clear of obstructions. LPA observed tables and chairs, scaled to the proper size, with labeled cubbies for added storage. Accessible furniture was free of sharp corners. The children’s bathrooms were observed clean, with fixtures in operating condition. Classrooms were equipped with additional cabinets of teaching supplies. Functioning child safety locks had been installed on the lower hanging cabinets. LPA observed diaper changing table available for staff. Per staff, padding on table is disinfected after each use. For solid waste, trash bins area available with tight-fitting lids.

For scheduled rest/ nap, facility has cots, labeled with each child’s names. Per staff, napping sheets and blankets are washed weekly on site. The classrooms had adequate ventilation, lighting, and was a comfortable temperature. Classrooms have a functioning telephone service; carbon monoxide (CO) detectors; and fully changed fire extinguishers: 2A:10BC located in the hallway. The cleaning compounds, detergents, medications, and other items which could pose a danger had been stored inaccessible to children. (REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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 05/09/2024 01:15 PM - It Cannot Be Edited


Created By: Luis Gomez On 05/09/2024 at 11:49 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: FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)
FACILITY NUMBER: 380505568

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(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
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At 11:40AM., 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: 05/24/2024
Plan of Correction
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Facility water outlets used for food preparation have been tested. Results show no exceedance of lead. Facility will submit LIC999, and complementary report at a later date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2024


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 (PRESCHOOL)
FACILITY NUMBER: 380505568
VISIT DATE: 05/09/2024
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At 9:40AM, LPA reviewed the outdoor play area. The climbing structure had been properly anchored with rubber padded flooring for added safety. LPA observed several shaded rest areas and water jug with cups available for the children to drink as they wish. Sandbox area was free of foreign objects or hazards items. Playthings including the tricycles and toys were in proper repair.

The food preparation/ storage areas were reviewed during inspection. Areas was observed clean and free of litter or rubbish.

At 10:15AM., LPA reviewed facility records, including a sample of the children’s and personnel files. The personnel files were reviewed and contained the Proof of Teacher Qualifications; Notice of Employee Rights (LIC9052); Acknowledgement to Report Suspected Child Abuse (LIC9108); and Personnel Record.

LPA reminded facility to ensure staff’s Mandated Reporter Training (AB1207) proof of completion certificate is stored in the personnel files.

At 11:40AM., Based on record review, LPA confirmed water testing for lead contamination levels was conducted after the 1/1/2023 deadline.

Administrator’s Cardiopulmonary Resuscitation / First Aid certification was current, and expires on: 4/2025.


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

LPA observed required postings including the: Facility License; Notification of Parent’s Rights (PUB394); Passenger Safety Laws (PUB269); and Emergency Disaster Plan (LIC610).

LPA reminded Administrative Director to post snack and lunch menu at least one week in advance. (REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 (PRESCHOOL)
FACILITY NUMBER: 380505568
VISIT DATE: 05/09/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

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 in 809D. Exit interview, and facility evaluation report was discussed with Administrative Director, Dee Lee. Administrator’s signature on this form acknowledges receipt of these documents.



This report must be made available in facility for public review. Notice of site visit was given and must remain posted for 30 days. Principal was advised, any additional questions/ concerns to contact the 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: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC809 (FAS) - (06/04)
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