384002282-9-29-2022-05-CC-LGOZ-CJQQQB-20220929122204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002282
Report Date: 09/29/2022
Date Signed: 09/29/2022 12:22:24 PM

Document Has Been Signed on 09/29/2022 12:22 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	LITTLE TREE PRESCHOOL		FACILITY NUMBER:	384002282
ADMINISTRATOR:	COCHRUM, GIGI		FACILITY TYPE:	850
ADDRESS:	3161 MISSION STREET		TELEPHONE:	(415) 647-7524
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 22	TOTAL ENROLLED CHILDREN: 22	CENSUS: 16	DATE:	09/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Gigi Cochrum		TIME COMPLETED:	12:35 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 9/29/2022 at 8:40AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Lead Teacher, Carolina Ferrucci. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Director, Gigi Cochrum arrived during inspection. Present was the lead teacher and three staff supervising 16 children. All staff have criminal record clearances on file. Children present have been signed in. Preschool program utilizes the large classroom, and one outdoor play area. Day and hours of operation are Monday- Friday, 8:30AM- 6:30PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 9:00AM., LPA observed the following: Facility was clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces were free of obstructions. Accessible furniture, books and materials inspected were in proper repair. Facility is equipped with labeled storage cubbies for children’s belongings. Classroom has several child sized tables and chairs for snack and activities. Children’s bathroom has adequate supplies and fixtures testing were operating condition. Staff bathroom is located separate. For napping services, stacked and labeled cots are stored in facility closet. LPA reminded director to ensure children’s napping supplies are washed weekly. Classroom acceptable ventilation and lighting. Detergents; cleaning supplies; compounds; and toxins are stored in the off-limit areas. Electrical outlets, vents, and trash bin have been covered. Classrooms had functioning carbon monoxide detector; and one (fully charged) fire extinguishers; 3A:40BC. Smoke detectors are built into the building. First aid kit was reviewed during inspection. At 9:20AM., LPA inspected facility’s outdoor play area. Outdoor area is completely enclosed with fencing. Available seating and a shaded rest area is accessible. LPA observed sandbox is properly covered, and free of foreign objects. Per lead teacher, water services are provided with use of containers and cups. LPA reminded facility to ensure all children's water bottles are properly labeled. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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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Document Has Been Signed on 09/29/2022 12:22 PM - It Cannot Be Edited

Created By: Luis Gomez On 09/29/2022 at 11:00 AM

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: LITTLE TREE PRESCHOOL	FACILITY NUMBER: 384002282
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interviews conducted, LPA confirmed staff's cardiopulmonary resuscitation/ first aid certification is expired. This poses a potential health and safety risk to children in care.
	POC Due Date: 10/21/2022
	Plan of Correction
1 2 3 4	Director will ensure staff member present in facility has completed the required CPR/ First Aid Certification prior to the due date: 10/21/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Cindy Interiano

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LITTLE TREE PRESCHOOL	FACILITY NUMBER: 384002282
	VISIT DATE: 09/29/2022

NARRATIVE

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(Page 2)
At 9:55AM, LPA reviewed the facility records including seven children’s files and four personnel files. Staff files reviewed included the: Notice of Employee Rights (LIC9052); Proof of Qualifications; Declaration to Report Suspected Child Abuse (LIC9108).

LPA reminded facility to ensure proof of required immunization are stored in the personnel files. Advisory Note: Technical Assistance (LIC9102TA) was issued during inspection.

At 10:10AM, Based on record review and interviews, LPA confirmed staff's 'Mandated Reporter Training' certifications (AB1207) are missing from facility files. Advisory Note: Technical Violation (LIC9102TA) was issued during inspection.

At 10:20AM., Based on record review and interviews conducted, LPA confirmed staff's cardiopulmonary resuscitation/ first aid certification is expired.

Children’s files were reviewed and included signed: Consent for Medical Treatment (LIC627); Identification of Emergency Information (LIC700); Health History (LIC702); Immunization Records; and Notification of Parent’s Rights (LIC995).

Emergency disaster drills are conducted in facility, with the last drill done on, 6/1/2022, properly logged.

Required forms and posted prominently in facility, including the Childcare License; Outdoor Space Waiver; Child Passenger Safety Laws; Notification of Parent’s Rights (PUB393); and Emergency Disaster Plan (LIC610).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
(REFER TO 809C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LITTLE TREE PRESCHOOL	FACILITY NUMBER: 384002282
	VISIT DATE: 09/29/2022

NARRATIVE

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Based on today's inspection, deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview, plan of correction, appeal rights, and report was reviewed with Director, Gigi Cochrum. Signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Any additional questions facility was advised to call Regional Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC809 (FAS) - (06/04)

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