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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002282
Report Date: 01/22/2024
Date Signed: 01/22/2024 12:07:45 PM

Document Has Been Signed on 01/22/2024 12:07 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:LITTLE TREE PRESCHOOLFACILITY NUMBER:
384002282
ADMINISTRATOR:COCHRUM, GIGIFACILITY TYPE:
850
ADDRESS:3161 MISSION STREETTELEPHONE:
(415) 647-7524
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 19DATE:
01/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Gigi CochrumTIME COMPLETED:
12:20 PM
NARRATIVE
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On 1/22/2024 at 8:40AM., Licensing Program Analyst (LPA), Luis Gomez and Director/ Licensee, Gigi Cochrum. Purpose of the inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate a preschool program. Present during inspection was the Director and four staff supervising 19 children, properly signed in. Facility staff have criminal record clearances of file. The program utilizes one classrooms and the outdoor play area. LPA inspected facility for health and safety hazards.

At 8:45AM., LPA observed the following: Classroom was clean and orderly, with age-appropriate playthings available for the children. The floor and ground surfaces were clear of obstructions or hazards. The classroom had been divided into several activity areas. LPA observed child- sized tables and chairs. Classroom was equipped with cubbies for storage of children's belongings. Furniture inspected was free of any sharp corners or splinters. The children’s bathroom was maintained clean with fixtures in operating condition. Per Director, the staff bathroom is located separately.

For nap services, LPA observed stackable, plastic cots stored in facility. Per director, napping sheets are washed weekly by staff. The facility has adequate ventilation and was a comfortable temperature for the children. Classrooms had sufficient lighting. Facility has a testable smoke/ carbon monoxide detector, telephone service, and fire extinguishers: 3A:40:BC. LPA reviewed the facility’s first aid kit during inspection. (REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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Document Has Been Signed on 01/22/2024 12:07 PM - It Cannot Be Edited


Created By: Luis Gomez On 01/22/2024 at 11:20 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: 01/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 9:35AM., Based on record review, LPA confirmed facility's fixtures, used for drinking water/ food preparation, have not been tested for lead contamination levels. This poses a potential health and safety risk to children in care.
POC Due Date: 02/05/2024
Plan of Correction
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Director will ensure water fixtures, used for ingestion or food preparation, is tested for lead contamination levels by the due date: 2/5/2024.
Proof of correction will be submitted to the Department via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2024


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: LITTLE TREE PRESCHOOL
FACILITY NUMBER: 384002282
VISIT DATE: 01/22/2024
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At 9:20AM., LPA inspected the outdoor play area. The outdoor area was completely enclosed, with shaded rest available. An absorbent material had been installed on the ground surface for added safety. Accessible sandbox had been properly covered. Per director, water services are provided both inside and outside with refillable cups.

At 9:30AM., LPA reviewed facility records including: 4 children’s files and 5 personnel files.

At 9:35AM., Based on record review, LPA confirmed facility's fixtures, used for drinking water/ food preparation, have not been tested for lead contamination levels.

Facility’s staff files were reviewed and contained the: Teachers Qualifications, Notice of Employee Rights (LIC9052), Personnel Record; Proof of required Immunization; and the ‘Mandated Reporter Training’ (AB1207) Certification.



Facility’s children’s files were reviewed, containing the: Immunization Records, Identification and Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Personal Rights (LIC613A) and ‘Written Medical Assessments’.

Facility personnel had their updated CPR/ 1st aid certification on file, expiring on 10/2024.


Required emergency disaster drills are being conducted every six months, with last drill completed on 10/23/2023, properly logged by director.

LPA observed required postings, posted near entryway including the: Facility License; Notification of Parent’s Rights (PUB394); Outdoor Space Waiver; Passenger Safety Law (PUB269); and Emergency Disaster Plan (LIC610) (REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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: LITTLE TREE PRESCHOOL
FACILITY NUMBER: 384002282
VISIT DATE: 01/22/2024
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LPA referred licensee, Gigi Cochrum, to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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/.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations and cited on 809D. Exit interview, report, and plan of correction was discussed with Director/ Licensee, Gigi Cochrum. Licensee's signature on this form acknowledges receipt of these documents.



This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director was advised any additional questions to call office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC809 (FAS) - (06/04)
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