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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000805
Report Date: 10/03/2023
Date Signed: 10/03/2023 02:11:09 PM

Document Has Been Signed on 10/03/2023 02:11 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 SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THEFACILITY NUMBER:
384000805
ADMINISTRATOR:BECERRA, PATRICIAFACILITY TYPE:
850
ADDRESS:3101 MISSION STREETTELEPHONE:
(415) 550-4178
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 13DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Amalia Justo, Patricia BacerraTIME COMPLETED:
12:05 PM
NARRATIVE
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On 10/3/2023 at 8:30AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Lead Teacher, Amalia Justo. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate a preschool-age program. Director, Patricia Bacerra arrived during inspection. Present was the director and 3 staff supervising 13 children. Children present had been signed in. Staff have criminal record clearances on file. Program utilizes one classroom, and Outdoor Play Area. Per director, preschool program operates year around. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 8:35AM., LPA observed the following: Classroom was clean, orderly, with age-appropriate playthings available for the children. Labeled cubbies are available for storage of children's belongings. Accessible furniture, books, and puzzles inspected were proper repair, and free of sharp corners or splinters. Classrooms had child- sized tables and chairs for seated activities. LPA observed children’s bathrooms maintained clean, with fixtures in operating condition. Staff bathroom is located separate. For napping services, labeled cots are stored in the facility. Napping items cots inspected were made of a cleanable material. Per Director, children napping supplies are washed weekly. Facility has acceptable ventilation and lighting. Trash bins and outlets have coverings installed. Classroom was equipped with testable carbon monoxide combination detector, functioning telephone, and several fully charged fire extinguishers: 2A:10BC located in kitchen. Facility’s first aid kit was reviewed and was fully stocked. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 10/03/2023 02:11 PM - It Cannot Be Edited


Created By: Luis Gomez On 10/03/2023 at 10:59 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 SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE
FACILITY NUMBER: 384000805

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:40AM., Based on record review, LPA confirmed staff's 'Mandated Reporter Training' Certification, (AB1207) were missing from the facility records. This poses a potential health and safety risk to children in care.
POC Due Date: 10/09/2023
Plan of Correction
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Director will ensure staff's updated 'Mandated Reporter Training' Certification (AB1207) are stored in the facility file by the due date: 10/9/2023.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 10:50AM., Based on record review and interview, LPA confirmed staff missing their updated (CPR) Cardiopulmonary Resuscitation, First Aid certification. This poses a potential health and safety risk to children in care.
POC Due Date: 10/09/2023
Plan of Correction
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Director will ensure staff's CPR/ 1st aid certification is updated by the due date: 10/9/2023.

Proof of correction will be submitted to the department via email.
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: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023


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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 SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE
FACILITY NUMBER: 384000805
VISIT DATE: 10/03/2023
NARRATIVE
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LPA inspected the outdoor play area. Area was completely enclosed, with toys and playthings for the children. Absorbent material had been installed around climbing structure and slide. Tricycles inspected were in good repair. Shaded resting area is available to children.

LPA reminded director to ensure fresh water is made available for children, outside. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 9:05AM., Based on observations, LPA confirmed cushioned rubber padding in the outdoor play area has several tears. Advisory Note: Technical Violation (LIC9102TV) was issued.

During inspection, LPA reviewed food preparation/storage room. Food items inspected had been properly stored. Area and items were observed clean and without trash or rubbish.

At 9:50AM LPA reviewed facility records including 5 children’s files and 3 personnel files. Children’s files were reviewed, and contained the: Consent for Emergency Medical Treatment (LIC627); Immunization Records, Identification and Emergency Information (LIC700); Personal Rights (LIC613A); Notification of Parent’s Rights (LIC995); and ‘Written Medical Assessments’.

Staff’s files were reviewed, and contained the: Notice of Employee Rights (LIC9052) and Personnel Record (LIC501).



At 10:40AM., Based on record review, LPA confirmed staff's 'Mandated Reporter Training' Certification, (AB1207) were missing from the facility records.

LPA reminded director to ensure staff's proof of required immunization are stored in the facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 10:50AM., Based on record review and interview, LPA confirmed staff missing their updated (CPR) Cardiopulmonary Resuscitation, First Aid certification.

Emergency disaster drill are conducted monthly. Last drill completed on 7/19/2023, is properly logged.

LPA observed required posting in facility, including the: Facility License; Emergency Disaster Plan (LIC610); Earthquake Preparedness Checklist; Notification of Parent’s Rights (PUB394); Updated Snack Menu (October); and Child Passenger Safety Laws (PUB369). (REFER TO 809C, FOR CONT.)

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

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
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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 SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE
FACILITY NUMBER: 384000805
VISIT DATE: 10/03/2023
NARRATIVE
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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/.

Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed child care centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN21-21- CCP.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Based on today's inspection, deficiencies were cited in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations. Exit interview, appeal rights and report was discussed with Director, Patricia Bacerra signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was given and must remain posted for 30 days. Director 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: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
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