384001206-7-3-2024-05-CC-JYEE-D6TP47-20240703105840

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001206
Report Date: 07/03/2024
Date Signed: 07/03/2024 10:58:47 AM

Document Has Been Signed on 07/03/2024 10:58 AM - 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MISSION HEAD START - JEAN JACOBS		FACILITY NUMBER:	384001206
ADMINISTRATOR:	VIVIAN LOPEZ		FACILITY TYPE:	850
ADDRESS:	459 VIENNA STREET		TELEPHONE:	(415) 469-2162
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY:	24	CENSUS: 10	DATE:	07/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Vivian Lopez		TIME COMPLETED:	11:15 AM

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	Licensing Program Analysts (LPA) Yee conducted an annual inspection today. The purpose of the inspection was explained. Present at the facility are 4 staff members, site director and 10 children. Teacher-to-child ratios is in compliance during today's visit. Days and hours of operation: Monday - Friday, 8:00 am - 4:30 pm. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The outside yard is adjacent to the classrooms. LPA and site director, Ms. Lopez toured and inspected the Center for Health and Safety Hazards. Daycare classrooms and Outdoor yard are inspected. LPA observed outdoor equipment is in good condition, free from loose, sharp, or pointed parts. There are no swimming pools, spas, or other bodies of water on the premises. All cleaning supplies and other potentially harmful items are made inaccessible to the children. Furniture and equipment are in good condition. The facility provides snacks, and lunches. Menu is posted. Drinking water is provided indoors and outdoors via water fountains. The last Fire Drill was conducted on 06-26-2024, and properly logged. During the visit, LPA reviewed two staff members' records. At least one staff have current Pediatric First Aid and CPR until 02/2025. An isolation room for a sick child is located inside the director office and will use staff bathroom as needed. Designate a teacher to stay with the child, then call parents for pick up. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. https://www.mandatedreporterca.com/ continue next page.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISSION HEAD START - JEAN JACOBS	FACILITY NUMBER: 384001206
	VISIT DATE: 07/03/2024

NARRATIVE

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The facility representative 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 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 Center (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. The facility had lead water tested and in compliance.

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)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at: http://www.ada.gov/resources/child-care-centers/.

The facility representative, Vivian Lopez was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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, by Vivian Lopez.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer Yee	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC809 (FAS) - (06/04)

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