384002434-2-22-2023-05-CC-BVAN-CPB32Y-20230222165242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002434
Report Date: 02/22/2023
Date Signed: 02/22/2023 04:52:51 PM

Document Has Been Signed on 02/22/2023 04:52 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH		FACILITY NUMBER:	384002434
ADMINISTRATOR:	JENNY LAM		FACILITY TYPE:	850
ADDRESS:	1011 GARFIELD STREET		TELEPHONE:	(415) 242-7135
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 32	CENSUS: 23	DATE:	02/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Shirley Li		TIME COMPLETED:	05:00 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	Licensing Program Analyst (LPA) Van conducted an unannounced annual mandated inspection and met with lead teacher Shirley Li. The purpose of the inspection was explained, and the staff granted LPA entry to the facility. The Center is located at the Lutheran Church of Our Savior. Present at the Center were six teachers who supervised 24 children. The Center operates within capacity requirements and in compliance with the child-to-staff ratio. Hours of operation are Monday to Friday from 7:30 am to 6:00 pm. LPA toured and inspected the physical plant for any health and safety hazards. The facility has an electronic sign-in/out, and sign-in/out codes are provided to the parents. The facility is in good repair and has proper temperature and ventilation. The classrooms have age-appropriate toys and learning materials. The furniture appears steady and in good repair. The facility has a carbon monoxide detector, a centralized smoke alarm, fully charged fire extinguishers, and working telephones. LPA observed that the children have a storage space with hooks for their backpacks/belongings. All emergency supplies are stored in locked storage. Medications are appropriately labeled and stored out of reach of children. First aid supplies are fully stocked and available for children's use. All cleaning solutions, poisons, and other dangerous chemicals are stored in a high cabinet in each classroom and are inaccessible to children. Sleeping cots are appropriately stored. The Center has four toilets and eight sinks for children, and the staff has a separate bathroom. All toilets and handwashing sinks are in good working condition with proper sanitation. LPA observed no bodies of water on the premises. The outdoor play area is completely fenced, clean, and in good repair. Outdoor toys are age-appropriate, in good condition, and free of loose parts. Continued on page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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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Document Has Been Signed on 02/22/2023 04:52 PM - It Cannot Be Edited

Created By: Brendon Van On 02/22/2023 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: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH	FACILITY NUMBER: 384002434
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the Center did not comply with the section cited above in two out of four teachers did not complete the required Mandated Reporter training AB1207, which poses/posed a potential health, safety, or personal rights risk to persons in care.
	POC Due Date: 03/01/2023
	Plan of Correction
1 2 3 4	The Center/Site Supervisor must ensure that all staff complete the Mandated Reporter Training bi-annually and are available for review during the inspection. The lead teacher states she will have the two teachers complete the training and send to completion to the Licensing office by March 1, 2023.

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:

Garfield Leung

LICENSING EVALUATOR NAME:

Brendon Van

LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH	FACILITY NUMBER: 384002434
	VISIT DATE: 02/22/2023

NARRATIVE

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The facility had posted the required forms. (i.e., License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, Emergency Disaster Plan, and Daily activities). Per the Director, the Center provides children with breakfast, lunch, and afternoon snacks. The menus and daily schedule were observed and posted. The children bring their water bottles. The Center also has water bottles available for children to refill. All storage containers for solid waste within the Center have a proper tight-fitting cover.
Random children's records and personnel records were reviewed during the inspection. Records review showed the facility has records of each child's authorized representative's names, addresses, and telephone numbers. In addition, each child's immunization record, medical assessment, and admission agreement can be located in each child's file. Staff records indicate that all staff or individuals requiring caregiver background checks have received criminal records and child abuse index clearances or exemptions. Multiple staff members have a record of valid CPR and maintain proper immunization records. LPA reviewed the educational qualification of staff, and all staff had the required ECE units. The lead teacher stated that the Center conducts fire and earthquakes at least once every six months; the last drill was conducted on 10/22/2022.
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 (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
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.
Continued on page 3...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH	FACILITY NUMBER: 384002434
	VISIT DATE: 02/22/2023

NARRATIVE

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The Director was informed about Mandated Reporter training. In addition to AB1207 training required to complete every two years by the Licensee and all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
LPA encouraged the Director to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Director can also email childcareadvocatesprogram@dss.ca.gov and ask for the updates to be added to the email list.

During the inspection, LPA requested the following documents to be sent to Licensing office by March 3, 2023. The Emergency Disaster Plan (LIC 610), Personnel Report (LIC 500), the Designation of Administrative Responsibility (LIC 308), Incidental Medical Services Plan (IMS), and updated Mandated Reporter training and Basic Pest Management Training of staff.

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/n-process.
See LIC 809D for the deficiency cited today. An exit interview was conducted, and the report was reviewed with the lead teacher, Shirley Li. Today's report, deficiency, and site visit notice were provided to the lead teacher. LPA informed the lead teacher that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

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