384000794-7-12-2024-05-CC-JTSE-D74U6F-20240712151817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000794
Report Date: 07/12/2024
Date Signed: 07/12/2024 03:18:38 PM

Document Has Been Signed on 07/12/2024 03:18 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:	MANCASOLA, AMY		FACILITY NUMBER:	384000794
ADMINISTRATOR/ DIRECTOR:	MANCASOLA, AMY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 290-3149
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94127
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 6	DATE:	07/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Licensee, Amy Mancasola		TIME VISIT/ INSPECTION COMPLETED:	03:35 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 7/12/2024, at approximately 1:00PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Amy Mancasola (L1), and explained the purpose of the visit. Present during the visit was L1, two helpers (H1 and H2), and six preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:00AM to 5:00PM. Daycare Areas in the Lower Level: The Art Room, Nap Room, Bathroom, Kitchen, and Backyard. Off-limits Areas: Two closets in the Lower Level, and the entirety of the Upper Level. LPA inspected the facility for any health or safety hazards. The facility is equipped with a fully charged 2A10BC fire extinguisher. There are three carbon monoxide detectors present throughout the daycare areas. There are no fireplaces in the daycare areas. Electrical outlets present in the home are tamper-resistant outlets. LPA observed cleaning detergents and other chemicals to be stored in cabinets that were accessible to children. L1 removed the cleaning detergents and chemicals and placed them in a location inaccessible to children during the visit. LPA advised that childproof latches could be used on cabinets intended for storage of chemicals or cleaning detergents. L1 stated that they understood. LPA observed the Art Room and the Nap Room to contain age-appropriate toys and learning materials. Furniture was observed to be free of rough or sharp edges. LPA advised that toys and learning materials shall be stored such that they are not hanging over the edges of shelves. L1 stated that they understood. Per L1, children nap on mats that are wiped daily. Children bring bedding from home and take them back once a week for cleaning. The facility provides filtered water and reusable cups for children. Drinking water is accessible for children as needed. Per L1, the facility provides AM/PM snacks for children, and children bring lunch from home. Lunches brought from home are checked for any allergenic foods, and extra food is available for children as needed. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

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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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: MANCASOLA, AMY	FACILITY NUMBER: 384000794
	VISIT DATE: 07/12/2024

NARRATIVE

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LPA observed the Backyard to be free of loose objects and debris. There is a play structure present that is cushioned by woodchips. LPA observed the play structure to be in good repair. Per L1, woodchips are replenished every summer. There are age-appropriate toys and equipment for children in care. Per L1, outdoor play is offered throughout the day. The Backyard is checked and swept through daily. There are no swimming pools or other similar bodies of water present in the facility. Per Licensee, there are no firearms or weapons stored in the home.

LPA reviewed four staff files, 12 children’s files, and facility records. L1’s Mandated Reporter Training expires 7/2025. LPA observed L1’s First Aid/CPR training to not be from an EMSA certified vendor. LPA advised that Pediatric First Aid/CPR training shall be from an EMSA certified vendor, the American Red Cross, or the American Heart Association. L1 stated that they understood. Staff immunizations were available for review. LPA discussed tuberculosis clearance requirements with L1 during the visit.

LPA observed children’s files to contain Emergency Identification and Information (LIC700) and immunization records. LPA advised that Notification of Parents’ Rights (LIC995A) shall be maintained in all children’s files, in addition to Consent for Emergency Medical Treatment (LIC627). L1 stated that they understood.

LPA advised that required postings shall be posted in a visible and accessible area of the facility. LPA recommended that required postings be posted in the entrance of the facility. L1 stated that they understood. The facility last conducted an emergency drill on 3/27/2024. All emergency drills are properly logged and documented.

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.

Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: MANCASOLA, AMY	FACILITY NUMBER: 384000794
	VISIT DATE: 07/12/2024

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

LPA discussed the safe sleep regulations with Licensee 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 licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

Licensee 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.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
No deficiencies were cited during today’s visit on 7/12/2024. See LIC9102-TV for technical violations issued today regarding Pediatric First Aid/CPR and storage of cleaning detergents/chemicals. See LIC9102-TA for technical assistance provided today regarding required postings. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Amy Mancasola.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

LIC809 (FAS) - (06/04)

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