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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001019
Report Date: 01/07/2025
Date Signed: 01/07/2025 03:53:38 PM

Document Has Been Signed on 01/07/2025 03:53 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:KAI MING HEAD START-RICHMONDFACILITY NUMBER:
384001019
ADMINISTRATOR/
DIRECTOR:
ELLEN PETERSON-ALLENFACILITY TYPE:
850
ADDRESS:426 33RD AVENUE, 2ND FLOORTELEPHONE:
(415) 386-3096
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 27DATE:
01/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Kelly LiTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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On 1/7/2025, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit and met with the Director, Kelly Li. LPA explained the purpose of the visit to the director.

Twenty-seven preschool-aged children and eight staff members were present during the visit. LPA reviewed all the parents' signatures in the electronic app, where parents sign their children in and out of the facility, and it was found to be complete. The eight staff members received criminal record clearance from the California Department of Social Services. The facility is within its capacity limits and ratios for today’s visit.

LPA observed that all required documents, such as the facility license, waivers, notification of parents’ rights, personal rights, car seat laws, emergency disaster plan, and daily activities schedule, were displayed and visible to the public.

The most recent emergency disaster drill was conducted on 12/10/2024, and the LPA observed that it was documented. LPA reviewed the emergency disaster drill log and found it was conducted monthly.

The facility was observed to have a first aid kit box, smoke and carbon monoxide detectors, and two fully charged fire extinguishers.

LPA inspected the indoor and outdoor areas to identify health and safety hazards. The facility was clean, safe, sanitary, and in good repair. Disinfectants, cleaning solutions, poisons, and other items that could pose a danger were stored in areas inaccessible to the children. All accessible cabinets and drawers in the classrooms were found to be free of hazardous materials or poisons.

LPA observed that the two classrooms had age-appropriate toys, furniture, educational materials, and designated storage space for each child. Electrical outlets were fitted with child safety covers to prevent children's access. One diaper-changing table was observed in the hallway within arm’s reach of a sink. The bathrooms were clean, fully operational, and equipped with suitable toileting equipment and sanitation products. Water pitchers were observed in the classrooms. Prescribed medications were observed in a backpack, which included the child’s and doctor’s names.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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 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: KAI MING HEAD START-RICHMOND
FACILITY NUMBER: 384001019
VISIT DATE: 01/07/2025
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There are no pools, spas, or bodies of water on the property.

The facility uses Lincoln Park, half a block from the facility, as an outdoor play area since the facility does not have outdoor space for the children. LPA observed that the facility has a City of San Francisco permit, which is required to use city-operated parks.

The preschool program currently provides food service for the children. Lunch menus are displayed in the facility. According to the director, some enrolled children have a documented allergy. The facility provides snacks for the children.

The facility offers cots for children to rest or nap. LPA observed that sheets and blankets were available for the children.

LPA reviewed the files of ten children and verified that their emergency contact and medical information were complete.

LPA reviewed five staff files and confirmed that all required forms were present. LPA found four staff members were current with their Pediatric First Aid/CPR certifications. The facility must have one certified Pediatric First Aid/CPR staff member. LPA found that four staff members completed twelve units in Early Childhood Education (ECE), which means they are qualified to be teachers. The fifth staff member was employed as a family advocate.

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.

Director 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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
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: KAI MING HEAD START-RICHMOND
FACILITY NUMBER: 384001019
VISIT DATE: 01/07/2025
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LPA discussed the safe sleep regulations with director 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 director 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.

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.

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

No deficiencies were issued today during LPA's visit.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Kelly Li.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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