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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002434
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:11:25 PM

Document Has Been Signed on 03/22/2022 01:11 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:YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCHFACILITY NUMBER:
384002434
ADMINISTRATOR:JENNY LAMFACILITY TYPE:
850
ADDRESS:1011 GARFIELD STREETTELEPHONE:
(415) 242-7135
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 32TOTAL ENROLLED CHILDREN: 25CENSUS: 19DATE:
03/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shirley Lo and Anne SenoresTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced Annual inspection. LPA met with staff and explained purpose of inspection. Site Coordinator Shirley Lo and Program Director Anne Senores arrived a short time later. Center is located at the Lutheran Church of Our Savior. Present at the center were the Program Director, Site Coordinator, four teachers, and 19 preschool age children. Center is operating within capacity requirements and in compliance to child to staff ratio. Hours of operation are Monday to Friday from 7:30am to 5:30pm but will return to normal hours of 7:00am to 6:00pm July 2022.

LPA inspected center with staff. Center consists of Classrooms 1-4, courtyard, and backyard. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The center has age appropriate toys and equipment which are in good condition in each classroom. Outdoor play area is fenced for supervision. Outdoor toys and equipment are age appropriate and in good condition. There are no bodies of water, firearms, or weapons on the premises.

All required postings are properly posted on the bulletin board in Classroom 1 where drop off and pick ups occur. School provides snacks and lunch through Chefables. Menu is posted. Food prep area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. All cleaning products and toxins are inaccessible to children. Two bathrooms are located separately from classrooms and is next door to Classroom 1. Each bathroom has two toilets and two sinks and are designated for male and female. Staff accompanies children to the bathroom. There is also a separate bathroom for staff. Bathroom areas appear to be clean, in good repair, and free of any hazards.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2022
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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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: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH
FACILITY NUMBER: 384002434
VISIT DATE: 03/22/2022
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Eleven children records reviewed were complete. All children have a record of emergency identification information on file. Five staff records reviewed were complete. All staff members have a criminal record clearance on file. Site Coordinator and one teacher have a Pediatric First Aid/CPR certificate which expires October 2022.

Last emergency drill was conducted in October 2021. Emergency drills are conducted at least once every six months and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone is available on-site.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

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 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 (US DOJ) 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH
FACILITY NUMBER: 384002434
VISIT DATE: 03/22/2022
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Facility representative 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.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with facility representative Anne Senores.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC809 (FAS) - (06/04)
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