380505725-5-12-2025-05-CC-CQUO-DGLV73-20250512161028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380505725
Report Date: 05/12/2025
Date Signed: 05/12/2025 04:10:40 PM

Document Has Been Signed on 05/12/2025 04:10 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:	ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT		FACILITY NUMBER:	380505725
ADMINISTRATOR/ DIRECTOR:	TUWAI, KATHY		FACILITY TYPE:	830
ADDRESS:	5200 DIAMOND HEIGHTS BLVD.		TELEPHONE:	(415) 550-1536
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94131
CAPACITY: 39	TOTAL ENROLLED CHILDREN: 39	CENSUS: 30	DATE:	05/12/2025
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Kathy Tuwai		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

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 May 12, 2025 at approximately 1:30pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with facility representative, Sheron Singh, explained the purpose of the visit and was granted entry to the facility. On April 29, 2025, LPA conducted an annual inspection to St. Nicholas Day Care and Preschool. LPA inspected infant classroom for health and safety hazards. LPA was unable to complete annual inspection for infant program during visit. LPA continued annual inspection for infant program during today's visit. Present during LPA's visit for infant component included 10 staff (including director) and 30 infant children. All staff present have fingerprint clearance on file. Licensing documents are properly posted and made available for review. Documents posted include program's daily class schedule and program's food menu. A childcare roster was also made available for LPA's review. Infant program (Caterpillar classroom) is separated between younger infants (3 months to 14 months) and toddlers (14 months to 24 months). Younger infant space includes areas for tummy time, eating, and sleeping. Toddler space includes areas for soft play, eating and activities. There is a separate room in the infant classroom that is designated for napping toddlers (older infants). Infant classroom includes soft furniture and materials that are appropriate for infants. There are carpets in the classroom that are free of stains. Per director, carpet is vacuumed daily by facility's janitorial services. Per director, carpets are also shampooed monthly or as needed. (Continue Report on Page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
	VISIT DATE: 05/12/2025

NARRATIVE

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There is a diaper changing table in the Caterpillar classroom that is within arm's reach to a sink. Per director, diapers and wipes are provided by the program, however, families are able to provide for their children. LPA observed diapers and wipes to be appropriately stored and labeled with children's individual names. There is a garbage bin with a tight fitting lid to dispose of dirty diapers. LPA observed poisons, cleaning solutions to be stored behind child safety locked cabinets and/or in classroom's high shelves, inaccessible to children. LPA did not observe any cleaning solutions stored in low cabinets or drawers in classrooms.

Younger infant children sleep in cribs while older infant children sleep on cots. LPA observed infants sleeping in cribs to be free of loose articles and objects. LPA observed mattress in cribs to have tight fitting sheets. Per director, sheets are laundered on site weekly or as needed. Cribs do not hinder the entrance or exit to classroom.

Staff maintain sleeping logs for napping infants. LPA reviewed random selection of sleeping logs for the months of March and April. LPA observed sleeping logs include the 15 minute time stamp of when the infant was checked on while sleeping, the infants' sleeping position and the initials of the staff member conducting the check. Daily reports for the infants are also maintained and provided to infants' families that include how much the infant ate and how often the infant's diaper was changed throughout the day.

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

Facility includes multiple fully charged fire extinguishers, multiple smoke detectors and multiple carbon monoxide detectors. LPA tested carbon monoxide detectors during April 29, 2025 visit, which were observed to be working. There are multiple first aid kits on site that are fully stocked.

There is a food preparation area in the infant classroom that is made off limits to children with a child safety gate. Food preparation area includes a refrigerator that stores infants' bottles. LPA observed bottles to be labeled with children's individual names. Per director, families bring bottles for their infants daily, however, there are extra bottles and materials on site if needed. Drinking water is made available to children with filtered water stations and purchased water jugs.
(Continue Report on Page 3...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

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: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
	VISIT DATE: 05/12/2025

NARRATIVE

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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.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Program utilizes a written sign in/out record that is located outside the facility. LPA observed children to be appropriately signed in to program. Staff also record the body temperature of each child and each staff member prior to entering facility. Program conducts emergency disaster drills at least once every six months that are documented and maintained. Last disaster drill was conducted March 11, 2025.

LPA reviewed 6 random, infants' records which include completed infant's needs and services plan. LPA also reviewed signed acknowledgement of receipt of licensing reports (LIC9224) in infants' records.

LPA reviewed random selection of staffs' records. LPA observed multiple staff on site with a current CPR/First Aid certification. Director was reminded Mandated Reporter training (AB1207) must be current for all teaching staff working with children. LPA observed an expired Mandated Reporter certificate for one teaching staff present. A technical violation was issued for expired certificate. Per director, certificate has been renewed and has not yet been placed in the file. LPA observed of the 6 staff files reviewed, 3 staff did not have a completed health screening form (LIC503). A type B citation was issued.

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

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication
and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/.

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

Facility was issued a Type B citation for incomplete staff records. A plan of correction was discussed. Appeal Rights were provided to director.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with director, Kathy Tuwai.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/12/2025 04:10 PM - It Cannot Be Edited

Created By: Catrina Quimbo On 05/12/2025 at 03:29 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: ST. NICHOLAS DAY CARE AND PRESCHOOL-INFANT	FACILITY NUMBER: 380505725
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 3 out of 6 staffs's records were missing a completed health screening report, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/12/2025
	Plan of Correction
1 2 3 4	Director stated they will have staff complete health screening report (LIC503). Proof of completed reports will be submitted to LPA no later than POC due 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.

	Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:

	Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

LIC809 (FAS) - (06/04)

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