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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002696
Report Date: 12/05/2024
Date Signed: 12/05/2024 02:49:31 PM

Document Has Been Signed on 12/05/2024 02:49 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:LITTLE ANGELS NURSERY SCHOOLFACILITY NUMBER:
384002696
ADMINISTRATOR/
DIRECTOR:		VILLON, CARMENFACILITY TYPE:
850
ADDRESS:610-A CORTLAND AVENUETELEPHONE:
(415) 722-7476
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 20TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
12/05/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Carmen VillonTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On December 5, 2024 @ approximately 8:50am, Licensing Program Analysts (LPAs) Maria Olguin-Leon and Catrina Quimbo met with Director Carman Villon for an unannounced annual inspection. Purpose of visit was explained. Present during LPAs’ visit included 2 teaching staff (including director) and 11 preschool children. Staff present have fingerprint clearance on file. Program operates Monday through Friday 8:00am to 5:30pm.

LPAs and director toured the classrooms for health and safety hazards. Facility operates a preschool program with a toddler option component. Currently there are no toddlers enrolled in program. Facility has kitchen and two separate classrooms, main classroom and second classroom (napping room) and an outdoor playground. Classrooms have proper temperature and ventilation. There are plenty of age-appropriate toys, furnishings, books, and learning materials all in good repair. Storage cubbies for children to store belongings are located at back of classroom and labeled with children’s names.

There are sufficient sleeping cots available for children in care. LPAs observed sleeping cots to also be labeled with children’s individual names. LPAs observed a playpen in second classroom. Per Director, parents provide sheets for cots/playpen that are sent home weekly for laundering. Children’s restroom is located in back of classroom and is equipped with one working toilet and one sink with no running hot water. Restroom is equipped with children’s toiletries. LPAs observed a changing pad in restroom. Facility has a separate restroom for staff usage. All cleaning products, chemicals and toxins are stored in high shelves, inaccessible to children. All trash cans are equipped with tight fitting lids.

At approximately 10:00am, licensee, Rabab Tawfik, arrived at facility and left facility at approxiamately 1:55pm.. The outdoor playground is surrounded with an at least 5 ft. fence. Outdoor area is equipped with a wooden playhouse, covered sandbox, child size furniture and garden. Outdoor flooring is red rubber tiles squares to cushion falls. All outdoor equipment is in good condition. LPAs did not observe any pools, spas, or other bodies of water. Per Director, there are no weapons or firearms on the premises.

Cont. Page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696
VISIT DATE: 12/05/2024
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Facility provides a food service which includes breakfast, lunch and two snacks to children in care. LPAs observed food to be stored properly in cabinets and refrigerated to prevent contamination. Facility is equipped with a kitchen for cooking meals. LPAs observed knives stored in kitchen to be in high shelves, inaccessible to children. LPAs observed door to kitchen to remain closed throughout visit.

LPAs observed children’s labeled water bottles for use, indoors or outdoors. Facility refills bottles from kitchen sink. First aid kit is fully stocked with medical supplies. Incidental Medical Services were discussed. Sick children are isolated in napping room, separate from other children in care.

LPAs reviewed sign in/sign out sheets located at entrance to facility. LPAs reminded director to have parents sign with full signatures. Facility has one fully charged fire extinguisher, a working carbon monoxide detector and a fire alarm system. Facility uses cell phone for communication with staff and for emergencies.

Children utilize local Bernal Heights playground daily. There is an approved park permit from SF Park and Recreation to utilize park that was previously submitted to department. LPAs observed enrolled children at park to wear uniform shirt, identifying the facility and facility number. Toys and materials brought from facility to playground are age appropriate. During today’s visit, LPAs hand delivered open space waiver that was discussed with director and licensee. LPAs reminded director to post open space waiver in facility with park permit.

LPA reviewed 6 random children’s records and 7 staff records. Children’s files were missing physician report (LIC701) and personal rights (LIC613A), two type “B” deficiencies were cited. All staff records were complete with required paperwork. Director has a current CPR/First aid certification. LPAs observed the following documents posted, Facility License, Notification of Parent's Rights, and Emergency Disaster Plan. Notification of Personal Rights and Car Seat Law were not observed to be posted, technical assistance was provided.

During visit, LPAs hand delivered approved exception for director, Carmen Villon. LPAs also provided director with Technical Support Program (TSP) flyer. LPAs advised director to participate in TSP.

Cont page 3..
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696
VISIT DATE: 12/05/2024
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LPA discussed the safe sleep regulations with Director 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 Director 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.

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/.

Director 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 verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Cont. page 4...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696
VISIT DATE: 12/05/2024
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Director was reminded that all staff are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPAs observed staff files to have a current Mandated Reporter certifications, available for review. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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

See page LIC809D for type “B” deficiencies cited today, under Title 22 Division 12 of the California Code of Regulation

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

Exit interview conducted and report was reviewed with Director, Carmen Villon. Appeal Rights were provided to Director.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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Document Has Been Signed on 12/05/2024 02:49 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 12/05/2024 at 01:03 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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. Director stated an emergency disaster drill has not been conducted since last year, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2024
Plan of Correction
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Director will conduct an emergency disaster drill with children. LPAs reminded director disaster drill must document the date the drill was conducted, the type of drill, how many children were present and any comments. Proof of disaster drill to be submitted to LPAs by POC due date.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 6 out of 6 children's files did not have LIC701 Physician's reports completed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/06/2025
Plan of Correction
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Director will provided parent's with LIC701 to be completed and signed by children's physician and will file in children's folder. Director will emaill copies of completed and signed LIC701 to LPAs for the children's files reviewed.
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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 12/05/2024 02:49 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 12/05/2024 at 01:03 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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 6 out of 6 children's files did not have LIC613A Personal rights completed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2024
Plan of Correction
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Director will provided parent's with LIC613A personal rights to be completed and signed by parents and will file in children's folder. Director will emaill copies of completed and signed LIC613A to LPAs for the children's files reviewed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


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