384001816-6-14-2023-05-CC-NGAA-CSSUJ3-20230614153653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384001816
Report Date: 06/14/2023
Date Signed: 06/14/2023 03:37:01 PM

Document Has Been Signed on 06/14/2023 03:37 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	PACIFIC PRIMARY - ORANGE SUN CAMPUS		FACILITY NUMBER:	384001816
ADMINISTRATOR:	STANCIL, MADONNA-DIRECTOR		FACILITY TYPE:	850
ADDRESS:	1501 GROVE STREET		TELEPHONE:	(415) 409-1961
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94117
CAPACITY: 75	TOTAL ENROLLED CHILDREN: 75	CENSUS: 53	DATE:	06/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:06 PM
MET WITH:	Madonna Stancil		TIME COMPLETED:	03:45 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 June 14, 2023 at approximately 01:00 PM, Licensing Program Analyst (LPA) Nathan Garcia met with Site Director, Madonna Stancil for an unannounced annual inspection. Purpose of the inspection was explained. There were a total of 53 children and 12 teachers present in the facility, the children were observed during nap time. Facility operates day care Monday - Friday 7:45am to 5:30pm. With Director, LPA inspected 4 day care rooms, music room and the outdoor space. LPA observed facility has combined smoke detectors and carbon monoxide detectors, 2 fully charged fire extinguisher model 3A40GR located in multiple areas of the hallways. The facility has a working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards. There are first aid supplies available in the classrooms and in the office. All bathrooms are in working condition. Individual items provided by the parents are labeled and stored appropriately. According to Madonna, the facility serves breakfast, lunch and snacks, all prepped and served at the facility. The parents still have a choice of bringing food from home and all diet sensitivities are accommodated. Per director, the children are provided through kitchen sink as main source of drinking water, as needed. All food is stored properly to avoid contamination. The water bottles are brought from home or cups on site are provided. Food preparation area is free of litter. Food is stored adequately to prevent contamination and properly labeled. There is water available for children in the yard as well as in the classrooms and emergency bags. *page 2 for continuation*

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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: PACIFIC PRIMARY - ORANGE SUN CAMPUS	FACILITY NUMBER: 384001816
	VISIT DATE: 06/14/2023

NARRATIVE

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LPA observed outdoor area and play structures are free from health and safety hazards. The sand boxes are well maintained and checked/covered after each use. There are a variety of toys and sport equipment available for the children. There are also sheds/bins and storage areas for the toys when they're not being used.

According to Madonna, the facility has done the water lead testing for the preschool license. LPA was given the results and LIC forms.

According to the director, the facility is using paper sign in/out sheets. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log and last drill was conducted on February 13, 2023. Per Madonna, drills are done every month, rotating them between lock down/fire and earthquake drills.

The LPA reviewed the facility records. LPA reviewed 6 children's files that were present at the time. All required files were available in folders. LPA reviewed 6 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. The facility has a set learning curriculum posted in the classroom.

The Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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: PACIFIC PRIMARY - ORANGE SUN CAMPUS	FACILITY NUMBER: 384001816
	VISIT DATE: 06/14/2023

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Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file.

LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

This facility provides Incidental Medical Services – IMS. According to the director, there are no children with allergies. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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/childqanda.htm

Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

Report was reviewed and signed by Site Director, Madonna Stancil.

Today’s report, and notice of site visit will be printed and given to the director.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC809 (FAS) - (06/04)

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