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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000805
Report Date: 01/22/2025
Date Signed: 01/22/2025 04:38:23 PM

Document Has Been Signed on 01/22/2025 04:38 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/
DIRECTOR:		BECERRA, PATRICIAFACILITY TYPE:
850
ADDRESS:3101 MISSION STREETTELEPHONE:
(415) 550-4178
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 11DATE:
01/22/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Amalia Justo, Patricia BacerraTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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On 1/22/2025 at 1:30PM., Licensing Program Analyst (LPA), Luis Gomez met with Teacher, Amalia Justo. The purpose of today's visit was explained and was for an unannounced, annual random inspection. This facility is licensed to operate a preschool-age program. Director, Patricia Bacerra arrived during inspection.
Present was Director and 3 staff supervising 11 children. The days and hours of operation are Monday- Friday, 7:30-5:30PM. Staff in facility have criminal record clearances on file. Children present had been signed-in by guardians. Program utilizes one classroom and one, shared, outside play area. LPA observed approved waiver, for shared use of outdoor space posted in facility. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 1:40PM., LPA observed the following: Classroom was clean, neat, with age-appropriate materials and playthings available for the children. Classroom was equipped with several tables, chairs, and labeled cubbies for storage of belongings. All furniture inspected was scaled to the appropriate size. The children’s bathroom was clean with available supplies for handwashing. Toilets and faucets inspected were in operating condition. Facility had extra drawers and cabinets for added storage. The kitchen/ storage areas were free of any liter/ rubbish, and all food items reviewed were current and properly stored.

For scheduled rest/ nap services, LPA observed stackable plastic cots available. Per teacher, blankets and supplies are washed weekly by families. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
Document Has Been Signed on 01/22/2025 04:38 PM - It Cannot Be Edited


Created By: Luis Gomez On 01/22/2025 at 03:32 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 SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE
FACILITY NUMBER: 384000805

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025

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 2:35PM., Based on record review, LPA confirmed facility testing of water outlets for lead contaminating had been completed after required due date. This poses a potential health and safety risk to children in care.
POC Due Date: 01/22/2025
Plan of Correction
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Lead testing result were submitted to LPA during inspection including facility sketch (LIC999), LIC9275, LIC9276.
Deficiency was cleared during inspection.
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 2:10PM., Based on observation, LPA confirmed pointed edges on wooden board in sandbox area. This poses a potential health and safety risk to children in care.
POC Due Date: 02/07/2025
Plan of Correction
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Facility will install covering on exposed corners of sandbox by due date, 2/7/2025.
Proof of correction will be submitted to LPA 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: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2025


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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: 01/22/2025
NARRATIVE
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(Page 2)
Facility has ventilation; lighting; and was a comfortable temperature. Facility had a functioning telephone service and fire extinguishers (2A10BC) and testable carbon monoxide detector.

At 2:05PM, LPA reviewed the outside play area. LPA observed absorbent rubber padding /turf installed around climbing structure. Area was completely enclosed with available shading available. The climbing structure was observed anchored to the ground.



LPA reminded licensee to fill holes on the turf padding near play structure. Per director, they are planning to replace the turf. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 2:10PM., Based on observation, LPA confirmed pointed edges on wooden board in sandbox area.

LPA observed available drink water served from refillable bottle and pitchers, for children drink as they wish.

At 2:30PM., LPA reviewed facility records including a sample of the children files and personnel files.
At 2:35PM., Based on record review, LPA confirmed facility testing of water outlets for lead contaminating had been completed after required due date.

The personnel files reviewed contained Teacher's Proof of Qualifications; Notice of Employee Rights (LIC9052); Acknowledgement to Report Suspected Child Abuse (LIC9108); Proof of Completed Mandated Reporter Training Course (AB1207); and Personnel Record.

Children’s files were reviewed and contained the: Identification and Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Consent for Emergency Medical Treatment (LIC627); Immunization Record; and Personal Rights (LIC613A).

Staff's Cardiopulmonary Resuscitation / First Aid certification was current, expiring on: 10/2025.


Facility emergency disaster drill was completed on: 12/5/2024.

Required postings including the: Facility License; Notification of Parent’s Rights (PUB394); Personal Rights (LIC613A); The Passenger Safety Laws (PUB269); Outdoor Space Waiver; Menus (January, 2025); and Emergency Disaster Plan (LIC610). (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
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: FAMILY SCHOOL CHILD DEVL.CTR.-BERNAL GATEWAY, THE
FACILITY NUMBER: 384000805
VISIT DATE: 01/22/2025
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LPA referred to the Department website regarding Lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

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 on 809D. An exit interview discussing facility evaluation report and plans of correction was conducted with Director, Patrica Bacerra. Director’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 provided and must remain posted for 30 days. Teacher 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: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
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