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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002419
Report Date: 04/26/2024
Date Signed: 04/26/2024 04:20:22 PM

Document Has Been Signed on 04/26/2024 04:20 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:SF WALDORF SCHOOL-NURSERY PROG. EASTFACILITY NUMBER:
384002419
ADMINISTRATOR/
DIRECTOR:		HEIDI SCHWARZENBACH,DIR.FACILITY TYPE:
850
ADDRESS:3105 SACRAMENTO STREETTELEPHONE:
(415) 931-2244
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: 17DATE:
04/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Lead Teacher, Nichola ClarkTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
NARRATIVE
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On 4/26/2024, at approximately 12:40PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Lead Teachers Nichola Clark (L1) and Susanna Von Rombs (L2). LPA explained the purpose of the visit. Present during the visit were nine teachers and 17 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:30AM to 5PM.

LPA inspected the facility for any health or safety hazards. LPA observed the facility to be in clean and orderly condition. The facility operates in two classrooms: the Elves’ Cottage and the Elves’ Corner. LPA observed there to be functioning carbon monoxide detectors in each classroom. There are fully charged fire extinguishers that are at least size 2A10BC. Electrical outlets are covered or obstructed by furniture when not in use to be inaccessible to children in care. Poisons, cleaning detergents, and other chemicals are stored inaccessible.

LPA observed age-appropriate toys and learning materials to be present in each classroom. Furniture is age-appropriate and free of rough or sharp edges. LPA observed cubbies to be available for each child in care. Children nap on mats that are provided by the facility. Children bring blankets from home, and the facility provides bedding and sheets. The facility provides breakfast, lunch, and snacks. The facility adjusts its menu to accommodate any children with food allergies. LPA observed children’s toilets and hand washing sinks to be operational. There are two sinks and two toilets in each classroom. Food preparation areas are maintained in a clean and orderly condition.

There is no outdoor play area on site at the facility. The facility has a waiver to use the lawn in the Swedenborgian Church for outdoor activity. There are no pools or other bodies of water in the facility. There are no weapons or firearms stored in the facility.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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 04/26/2024 04:20 PM - It Cannot Be Edited


Created By: Jonathan Tse On 04/26/2024 at 03:41 PM
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: SF WALDORF SCHOOL-NURSERY PROG. EAST
FACILITY NUMBER: 384002419

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2024

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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Based on record review, the licensee did not comply with the section cited above by not testing according to Written Directives which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/27/2024
Plan of Correction
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Licensee shall conduct lead water testing of all applicable fixtures by set due date of 5/24/2024.
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
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Based on record review, the licensee did not comply with the section cited above by not having staff present with current Pediatric First Aid/CPR training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/10/2024
Plan of Correction
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Licensee shall have at least one staff member present in the facility with current Pediatric First Aid/CPR training. Licensee shall enroll staff in Pediatric First Aid/CPR courses and submit proof of enrollment to LPA by set due date of 5/10/2024. Licensee shall then provide proof of completion to LPA once certificates have been obtained.
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:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2024


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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: SF WALDORF SCHOOL-NURSERY PROG. EAST
FACILITY NUMBER: 384002419
VISIT DATE: 04/26/2024
NARRATIVE
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LPA reviewed six staff files, five children’s files, and facility records. LPA observed that no staff present had current First Aid/CPR certification on file. See LIC809-D for deficiency cited today regarding First Aid/CPR training. All children’s files contained immunization records and signed physician’s reports. All required postings are posted and accessible for review.

Based on record review of the facility’s lead testing results, LPA confirmed that the facility did not complete lead testing in accordance with the Written Directives specified in PIN 21-21_1-CCP. LPA discussed lead testing requirements and provided a copy of the Written Directives. See LIC809-D for deficiency cited today regarding lead water testing.

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.

Facility representative 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.

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. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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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: SF WALDORF SCHOOL-NURSERY PROG. EAST
FACILITY NUMBER: 384002419
VISIT DATE: 04/26/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/.

Facility representative 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.

See LIC809-D for deficiencies cited today regarding lead water testing and First Aid/CPR training. See LIC9102-TV for technical violations issued today regarding maintenance of personnel and children’s records at the facility, and Mandated Reporter Training requirements.

Appeal rights were provided and explained. 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, Administrative Director Craig Appell.

Report was emailed to Administrative Director Craig Appell.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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