384002479-8-31-2022-05-CC-BVAN-CHTQD8-20220831120420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002479
Report Date: 08/31/2022
Date Signed: 08/31/2022 12:04:36 PM

Document Has Been Signed on 08/31/2022 12:04 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:	LANGUAGE IN ACTION-NOE VALLEY MINISTRY (PS)		FACILITY NUMBER:	384002479
ADMINISTRATOR:	MUNOZ, KAREN		FACILITY TYPE:	850
ADDRESS:	1021 SANCHEZ STREET		TELEPHONE:	(415) 310-1335
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94114
CAPACITY: 49	TOTAL ENROLLED CHILDREN: 49	CENSUS: 33	DATE:	08/31/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Norma Sarai Montecinos		TIME COMPLETED:	12:30 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 August 31, 2022, Licensing Program Analyst (LPA) Van met with Lead Teacher Norma Sarai Montecinos for an unannounced annual random inspection. The purpose of the inspection was explained and granted entry to the facility by the teacher. The lead teacher informed LPA that the Director, Karen Munoz, is currently on maternity leave and expects a return date after the Labor day holiday. Present today are 33 children supervised by eight staff. The facility complies with the staff-children ratios today. The days and operations hours are Monday - Friday from 8:00 am to 6:00 pm. LPA toured and inspected the physical plant for any health and safety hazards. The facility utilizes a Sandbox app for sign-in /out for parents or authorized representatives; sign-in/out codes are provided to the parents. The facility is in good repair and has proper temperature and ventilation. Classrooms have age-appropriate toys and learning materials. Furniture appears steady and in good repair. The facility has multiple carbon monoxide detectors, a centralized smoke alarm, fully charged fire extinguishers, and working telephones. LPA observed that each child has their cubbies available with their name labeled. 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 an area inaccessible to children. Sleeping cots are appropriately stored. Continued on page 2..,

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: LANGUAGE IN ACTION-NOE VALLEY MINISTRY (PS)	FACILITY NUMBER: 384002479
	VISIT DATE: 08/31/2022

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
26
27
28
29
30
31
32

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 play structures are age-appropriate, in good condition, and free of loose parts. LPA reminded the lead teacher and the Center owner, Amory Donohue, over the phone that the Center must abide by the outdoor waiver limitation and maintain no more than 18 children in the outdoor play area at any time.

The facility had posted the required forms. (i.e., License, waivers, 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 two snacks and lunch. The menu is observed posted. The food preparation area is adequately equipped, clean, and free of hazards; this area is made inaccessible to children. The facility has water pitchers readily available for children indoors and outdoors. All storage containers for solid waste within the Center have a proper tight-fitting cover.

Ten 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. All staff maintained immunization records. LPA reviewed the educational qualification of the staff, and all staff had the required ECE units. The lead teacher stated that the Center conducts fire and earthquakes monthly; the last drill was on August 3, 2022.
Continued on page 3...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: LANGUAGE IN ACTION-NOE VALLEY MINISTRY (PS)	FACILITY NUMBER: 384002479
	VISIT DATE: 08/31/2022

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
26
27
28
29
30
31
32

This facility provides Incidental Medical Services – IMS. LPA reviewed the 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 lead teacher 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.

The lead teacher 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 lead teacher to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Director can also email at childcareadvocatesprogram@dss.ca.gov and ask for the updates to be added to the email list.

Continued on page 4...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LANGUAGE IN ACTION-NOE VALLEY MINISTRY (PS)	FACILITY NUMBER: 384002479
	VISIT DATE: 08/31/2022

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
26
27
28
29
30
31
32

During the inspection, LPA requested the following document be sent to the Licensing office by September 16.
1. an up-to-date Emergency Disaster Plan (LIC 610)
2. Personnel Report (LIC 500)
3. Designation of Administrative Responsibility (LIC 308).
4. Updated Mandated reporter training for all teachers

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.

No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the lead teacher, Norma Sarai Montecinos. Today's report 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: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4