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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002696
Report Date: 12/13/2022
Date Signed: 12/13/2022 03:48:13 PM

Document Has Been Signed on 12/13/2022 03:48 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:LITTLE ANGELS NURSERY SCHOOLFACILITY NUMBER:
384002696
ADMINISTRATOR:OUELLETTE, JOYFACILITY TYPE:
850
ADDRESS:610-A CORTLAND AVENUETELEPHONE:
(415) 722-7476
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 20TOTAL ENROLLED CHILDREN: 19CENSUS: 16DATE:
12/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Rabab TawfikTIME COMPLETED:
04:00 PM
NARRATIVE
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On December 13, 2022 at approximately 10:55am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with lead teacher, Anayeli Franco, and explained the purpose of inspection. Per lead teacher, director is licensee, Rabab Tawfik, and will arrive at a later time.

Present during LPA's visit included lead teacher, 3 staff members and 16 children (2 toddlers and 14 preschool age). Facility is operating within capacity limits and ratio during LPA's visit. Hours of operation are Monday to Friday 8:00am to 5:30pm.

Facility is a preschool center with a toddler option program. With lead teacher, LPA inspected the entire facility for health and safety hazards. Day care areas include two separate classrooms: main classroom, second classroom (napping room/playroom) and outdoor play yard. LPA observed classrooms to be properly ventilated. Day care areas are equipped with a variety of age appropriate toys and materials that were in good working condition. Cots and mats are utilized for napping children. Per lead teacher, cots, mats and sheets are cleaned and sanitized weekly or as needed.

Storage for children's belongings are located inside the main classroom, labeled with each child's individual names. LPA observed facility to have multiple fully charged fire extinguishers, multiple first aid kits and fire alarm system implemented.

Facility also contains a kitchen that is off limits to children. LPA observed poisons, cleaning solutions and hazardous materials to be stored in kitchen. LPA reminded lead teacher door to off limit kitchen should remain closed at all times.
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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696
VISIT DATE: 12/13/2022
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Facility provides a food service that includes breakfast, lunch, and two snacks. LPA observed kitchen and food prep areas to be orderly. All food is stored and prepared properly to avoid contamination.

Children's restroom is located in main classroom. LPA observed bathroom to be in proper working condition, equipped with appropriate sanitation products. There is a second restroom that is used for staff purposes only. Accessible children's sinks to not provide water that is warmer than 120 degrees Farenheit.

There is a diaper changing station in second classroom, that is within arm's reach to an adult sink. LPA observed disposed diapers and wipes in a garbage bin located in classroom without any lid. Per lead teacher, diapers are disposed of in open garbage bin which is then disposed of twice a day.

Water is made available throughout the facility through children's individual water bottles that are refilled at center.

At approximately 11:30am, licensee, Rabab Tawfik, arrived to facility. LPA continued annual inspection with licensee. Entire outdoor area is fully fenced with an at least 4 ft. high fence. Outdoor area was observed to have sufficient toys and materials that were in good working condition. Per licensee, children have daily walks to Bernal Heights park in addition to outdoor play area on site. Outdoor area includes a sandbox, wooden playhouse and garden. LPA did not observe outdoor area to have loose articles or debris.

LPA asked licensee of director on site. Per licensee, director on site continues to be Joy Oulette. Licensee stated director is currently out for personal reasons. LPA did not observe a completed designated of facility responsibility in event director or licensee are not present. LPA reminded licensee department needs to be made aware of who is designated with facility responsibility within 10 days. Licensee stated they understood.

Facility has license documentation and outdoor waiver properly posted and available for review. LPA did not observe Parent's Rights (PUB393) to be posted anywhere in facility. LPA reminded licensee poster must always be posted. LPA was unable to review center's emergency disaster drill log as drills were not documented. Per licensee, drills are completed at least once every six months. LPA reminded licensee disaster drills must be conducted, properly logged, and available for review.

At approximately 2:00pm, licensee left facility. Present during LPA's visit included 4 staff and 16 children whom were all sleeping.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
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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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696
VISIT DATE: 12/13/2022
NARRATIVE
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LPA reviewed 6 children's records that were complete. Children's files have a record of emergency identification information on file. LPA reviewed 4 staff members who were present during LPA's visit. At least one staff member on site has a current CPR certification that will expire 07/2024.

At approximately 3:00pm, licensee returned to facility. LPA reminded of all licensing documents that are needed to be maintained for all staff present.

Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Licensee is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA encourages the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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/inspection-process.

Licensee 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 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.
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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
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Document Has Been Signed on 12/13/2022 03:48 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 12/13/2022 at 02:35 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: 12/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

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 having at least 3 staff members on site, to not have fingerprint clearance on file, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/14/2022
Plan of Correction
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Licensee stated all 3 staff members have gone through fingerprinting process, however, did not have records of completed Livescan forms or Background clearance letters available for review. Licensee will either have all 3 staff members go through live scan process again or will submit appropriate documentation to department to request a fingerprint transfer.
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:Cindy Interiano
LICENSING EVALUATOR NAME:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022


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Document Has Been Signed on 12/13/2022 03:48 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 12/13/2022 at 02:35 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: 12/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

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 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2023
Plan of Correction
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Licensee emergency drills are conducted every six months, however, did not have proof or documentation of disaster drills. Proof of a completed emergency disaster drill will be submitted to LPA no later than 01/13/2023 by 5:00pm.
Type B
Section Cited
CCR
101218.1(c)
Admission Procedures and Parental and Authorized Representative's Rights
(c) The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times.

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 not posting the PUB 393, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/14/2022
Plan of Correction
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LPA provided licensee with PUB393. During LPA's visit, licensee posted Notification of Parents' Rights.
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:Cindy Interiano
LICENSING EVALUATOR NAME:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 12/13/2022 03:48 PM - It Cannot Be Edited


Created By: Catrina Quimbo On 12/13/2022 at 02:35 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: 12/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(f)(1)
Fixtures, Furniture, Equipment and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in having a waste bin with used diapers located in classroom, not to have a tightfitting lid, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2023
Plan of Correction
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Licensee stated a garbage bin with a tight fitting lid will be placed in classroom. Licensee is aware an open, waste bin with used diapers and wipes in classroom must be made inaccessible to children inc are. Licensee to provide proof of garbage bin with tight fitting lid in classroom to LPA no later than 01/13/2023 by 5:00pm.
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:Cindy Interiano
LICENSING EVALUATOR NAME:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022


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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: LITTLE ANGELS NURSERY SCHOOL
FACILITY NUMBER: 384002696
VISIT DATE: 12/13/2022
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Incidental Medical Services (IMS) policy was discussed. Program is providing IMS at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

LPA Quimbo informed licensee, Rabab Tawfik, that this report dated 12/13/2022 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Quimbo informed the licensee to provide a copy of this licensing report dated 12/13/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Licensee was cited one Type A citation for having 3 staff members on site not having proof of fingerprint clearance. Licensee was cited Type B citations for having no records of a completed emergency disaster plan, not posting PUB393, and having an open garbage bin without a tight fitting lid. Please refer to 809D for more information.

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

Exit interview conducted and report was reviewed with licensee, Rabab Tawfik.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
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