384000923-7-16-2024-05-CC-JTSE-D78UHW-20240716153638

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000923
Report Date: 07/16/2024
Date Signed: 07/16/2024 03:36:52 PM

Document Has Been Signed on 07/16/2024 03:36 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:	CHIBI-CHAN PRESCHOOL		FACILITY NUMBER:	384000923
ADMINISTRATOR/ DIRECTOR:	KANZAKI, SHOSHANA		FACILITY TYPE:	850
ADDRESS:	2507 PINE STREET		TELEPHONE:	(415) 351-0955
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94115
CAPACITY: 56	TOTAL ENROLLED CHILDREN: 56	CENSUS: 37	DATE:	07/16/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:35 PM
MET WITH:	Program Director, Shoshana Kanzaki		TIME VISIT/ INSPECTION COMPLETED:	03:50 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 7/16/2024, at approximately 1:35PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Program Director, Shoshana Kanzaki (D1), and explained the purpose of the visit. Present during the visit was D1, Site Supervisor Lisa Ma (D2), 9 staff members and 37 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility's operating hours are from 7:30AM to 6:00PM. LPA and D1 inspected the facility for any health or safety hazards. The facility is equipped with a fully charged 2A10BC fire extinguisher. There is an operational carbon monoxide detector in the facility. There is a fire alarm system running throughout the facility. Evacuation routes are posted and accessible for review. Emergency exits are clearly marked and visible. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Electrical outlets are covered or obstructed by furniture when not in use to be inaccessible to children. The facility operates in three classrooms: Caterpillars, Butterflies, and Astronauts. LPA observed age-appropriate toys and learning materials to be present. Furniture is age-appropriate and free of rough or sharp edges. Children nap on cots that are provided by the facility. Per D1, cots are sprayed down and washed. Children bring blankets and bedding from home and take it back once a week for cleaning. Per D1, the facility provides AM/PM snacks for children in care while children bring lunch from home. Children bring water bottles from home and the facility refills them as needed using filters. Cubbies are available for each child in care. LPA observed the outdoor play area to be free of debris and other loose articles. There are age-appropriate toys and equipment present. There is a play structure that is cushioned with resilient padding. There is a sandbox present. Per D1, the sandbox is checked every morning and covered at the end of each day. Shade is available with the use of large umbrellas. Children have access to drinking water while they are outside. The outdoor play area is enclosed by a fence that is at least four feet high. There are no pools or other similar bodies of water present in the facility. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

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: CHIBI-CHAN PRESCHOOL	FACILITY NUMBER: 384000923
	VISIT DATE: 07/16/2024

NARRATIVE

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LPA reviewed five staff files, five children’s files, and facility records. There is at least one staff member present with current Pediatric First Aid/CPR training. Staff qualifications and immunizations are available for review. All children’s files reviewed were observed to be complete. LPA observed all required postings to be posted and accessible for review. The facility last conducted an emergency drill on 6/25/2024. Drills are properly logged and documented. Children are signed in via paper sign-in/out.

The facility sampled its fixtures for lead on 9/28/2023. Test results showed no exceedances of lead in all fixtures tested. The facility is in compliance with lead testing requirements, and the next lead testing is due on 9/2028.

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.

Facility representative was reminded that all adults 18 and over, 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.

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. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: CHIBI-CHAN PRESCHOOL	FACILITY NUMBER: 384000923
	VISIT DATE: 07/16/2024

NARRATIVE

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

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-care-centers/.

Facility representative 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.

No deficiencies were cited during today’s visit on 7/16/2024. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Lisa Ma.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

LIC809 (FAS) - (06/04)

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