384002434-12-9-2025-05-CC-CQUO-DP7RYT-20251209122651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002434
Report Date: 12/09/2025
Date Signed: 12/09/2025 12:27:02 PM

Document Has Been Signed on 12/09/2025 12:27 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:	YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH		FACILITY NUMBER:	384002434
ADMINISTRATOR/ DIRECTOR:	ALVAREZ, KATIA		FACILITY TYPE:	850
ADDRESS:	1011 GARFIELD STREET		TELEPHONE:	(415) 242-7135
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94132
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 23	CENSUS: 16	DATE:	12/09/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:40 AM
MET WITH:	Shirley Li		TIME VISIT/ INSPECTION COMPLETED:	12:45 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 December 9, 2025 at approximately 8:40am, Licensing Program Analyst (LPA) Quimbo conducted an unannounced, annual inspection. LPA met with lead teacher, Yan Fang "Fallon" Lin, and explained the purpose of the visit. LPA was granted entry into facility. Upon LPA's arrival, program director, was not present. Hours of operation are Monday through Friday 7:30am to 6:00pm. YMCA program operates at Luther Church of Our Savior. YMCA program is licensed to operate in classrooms #1 through #4. The Penguin classroom (3.5 years to 5 years old) operates in rooms #2, 3 and 4. LPA observed Penguin classroom to be one large, open classroom. The Sea Turtles classroom (2 years to 3.5 years old) operates in room #1. Preschool program office is located on the second level of the facility in room #6. At approximately 9:10am, program director, Shirley Li, arrived to facility. With program director, LPA inspected day care areas, indoors and outdoors, for health and safety hazards. Present during LPA's visit included 16 preschool children, program director, and 4 teaching staff. All teaching staff present have fingerprint clearance on file. Preschool program is operating within capacity limits and ratio during LPA's visit. Preschool classrooms include toys, materials and children's furniture that are in good condition. There are rugs in the classrooms that are clean, free of stains. Per program director, rugs are vacuumed daily by facility's maintenance. LPA observed classrooms to include areas for library/quiet space, science, math, dramatic play, and building. LPA observed classrooms to be organized. Children's equipment are age appropriate and are in good condition. Per program director, children's materials are sanitized daily. There are cubbies in classrooms for children's personal belongings. LPA observed cubbies to be labeled with children's individual names. (Continue Report on Page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH	FACILITY NUMBER: 384002434
	VISIT DATE: 12/09/2025

NARRATIVE

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LPA observed multiple, fully charged fire extinguishers throughout the facility. There are also multiple first aid cabinets and emergency backpacks on site. LPA observed emergency backpack to include emergency contact information, a first aid kit and change of clothes for children. Facility is equipped with a smoke alarm system and carbon monoxide detectors. During today's visit, at least one carbon monoxide detector was working. LPA observed cleaning solutions and poisons to be stored behind child safety locked cabinets in classrooms. LPA also observed electrical outlets in classrooms to have child safety blocks.

Preschool program's restroom is located outside the classrooms. Restrooms are separated between a "boys" and "girls" restroom. LPA observed restrooms to be in working condition and equipped with age appropriate toileting equipment. Sinks accessible to children (inside the classroom and in the restroom) do not provide water that is warmer than 120 degrees Fahrenheit. There are garbage bins throughout the facility with tight fitting lids.

Preschool children sleep in the classroom on cots. Cots are stored in the outdoor area when not in use, fully covered. LPA observed cots to be labeled with children's individual names or photos. Sheets and blankets are provided by children's families and are stored in individual cubbies, so that they are not touching each other. Per program director, sheets are sent home weekly for laundering.

There are two outdoor areas for preschool program's use: Courtyard and Backyard. Per program director, backyard is not currently in use. LPA observed courtyard to be free of loose debris. There is a climbing wall and structure in the courtyard with resilient padding underneath. There is also a garden in the courtyard that is used by children with staffs' supervision. LPA did not observe any pools, spas or bodies of water on site.

Drinking water is available to preschool children, both indoors and outdoors, with children's individual water bottles. Water bottles can be refilled on site through accessible drinking fountains. Preschool program provides a food service that includes breakfast, lunch and snack. Food service is delivered to facility daily. Reusable utensils and plates are utilized for children and are sanitized in facility's dishwasher.

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.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

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: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH	FACILITY NUMBER: 384002434
	VISIT DATE: 12/09/2025

NARRATIVE

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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 verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP. Child care center completed testing and no lead exceedances.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water/testing-information)

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 PIN 22-02-CCP. 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-carecenters/

Children are signed into and out of program through an electronic application. Per program director, every family has a unique number when signing a child into the program. After using unique number to sign into electronic application, each authorized representative physically signs their child into and out of program. LPA observed 16 children to be signed into preschool program during today's visit. LPA also reviewed random sign in sheet from November 2025, which was maintained. LPA observed sign in and out sheets to include the name of a child, their date of birth, the time the child is signed into and out of program and the legal, electronic signature of the individual signing the child into and out of the program.

Licensing documentation is posted in the Penguin classroom, available for review. A childcare roster is maintained and was made available for LPA's review. Emergency disaster drills are conducted and documented. Last documented emergency disaster drill was conducted 10/16/2025. Isolation area for sick children is located in the program director's office (second floor), if needed.

During today's visit, LPA reviewed six random children's files. Children's files were complete with a record of required immunizations, emergency and admission information. LPA also reviewed all teaching staffs' files which were also complete. Teaching staff records are complete with educational transcripts or permits and immunization requirements. All teaching staff present have current Mandated Reporter certificates and current CPR and First Aid certifications that were made available for LPA's review.
(Continue Report on Page 4...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

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: YMCA OF SF., STONESTOWN BRANCH, LUTHERAN CHURCH	FACILITY NUMBER: 384002434
	VISIT DATE: 12/09/2025

NARRATIVE

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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.

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 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.

During today's visit, no deficiencies were issued.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Shirley Li.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025

LIC809 (FAS) - (06/04)

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