384002962-6-26-2024-05-CC-JTSE-D6LQ2G-20240626114707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002962
Report Date: 06/26/2024
Date Signed: 06/26/2024 11:47:28 AM

Document Has Been Signed on 06/26/2024 11:47 AM - 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:	CHIBI CHAN TOO		FACILITY NUMBER:	384002962
ADMINISTRATOR/ DIRECTOR:	YIP, JENNIFER		FACILITY TYPE:	850
ADDRESS:	800 PRESIDIO AVE		TELEPHONE:	(415) 202-7905
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94115
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 36	CENSUS: 14	DATE:	06/26/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:40 AM
MET WITH:	Site Supervisor, Jennifer Yip		TIME VISIT/ INSPECTION COMPLETED:	12:00 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	On 6/26/2024, at approximately 8:40AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Site Director, Jennifer Yip (D1), and explained the purpose of the visit. Present during the visit was D1, seven staff members, and 14 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 7:30AM to 6:00PM, Monday to Friday. Upon entry to the facility, LPA was informed by D1 that there was a field trip on this day. LPA observed the facility to meet and exceed the ratio of one adult for every six children with parent volunteers. D1, six staff members, all volunteers, and children left the facility at approximately 9:30AM. LPA continued the visit with Program Director, Shoshana Kanzaki (D2). The facility is located on the premises of Booker T. Washington Community Service Center. LPA inspected the facility for any health or safety hazards. LPA observed there to be a fully charged 2A10BC fire extinguisher. There are functioning carbon monoxide and smoke detectors present. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Off-limits areas are rendered inaccessible using childproof gates. Electrical outlets are covered or rendered inaccessible by furniture to be inaccessible to children in care. The facility operates in two classrooms, Dolphins (ages 2 to 3.5 years) and Sharks (ages 3.5 to 5 years). LPA observed age-appropriate toys and learning materials to be present in each classroom. Furniture was observed to be free of rough or sharp edges. Waste bins are fitted with tight-fitting lids. There are cubbies available for each child in care. Per D1, cots are provided and wiped down every day. Children bring blankets from home and take them back once a week for cleaning. Per D1, the facility offers snacks while children bring lunch from home. Water is provided and accessible with filters. Children bring water bottles from home. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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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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: CHIBI CHAN TOO	FACILITY NUMBER: 384002962
	VISIT DATE: 06/26/2024

NARRATIVE

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Each classroom is equipped with two toilets and two handwashing sinks. LPA observed a first aid kit to be fully equipped and stocked. The facility has a field trip bag that contains a first aid kit, medication as needed, and emergency contact cards for all children in care.

LPA observed the outdoor play area to be free of debris and other loose articles. The facility has a waiver that allows for rotating use of the outdoor play area for up to 23 children at a time. LPA observed copies of the waiver to be posted in the facility. D1 confirmed that the facility remains in compliance with the outdoor waiver. There is a play structure that is approved for use by children from the ages of two to five. There is resilient padding in the form of rubber padding and artificial turf. Equipment and toys were observed to be in good repair. The outdoor play area is enclosed by a fence that is at least four feet high. There are no pools or other bodies of water in the facility.

LPA reviewed five staff files, six children’s files, and facility records. LPA observed there to be at least one staff member with current Pediatric First Aid/CPR training. Staff maintain current Mandated Reporter Training. Staff qualifications and immunizations are available for review. LPA observed all children’s files to be complete. LPA observed required postings to be posted and accessible for review in the entryway to each classroom. LPA advised that LIC613A (Child Care Personal Rights) be posted as well. Children are signed in using paper sign-in/out sheets.

LPA observed that there was one staff member (S4) who was not associated to the facility. LPA observed that S4 did have a prior fingerprint clearance that was still active. LPA discussed fingerprint and association requirements with D2. LPA informed D2 that a Type A deficiency will be cited today and a civil penalty of $100 will be assessed for not associating S4 to the facility. D2 stated that they understood.

The Booker T. Washington Community Service Center was constructed after 2010. The facility does not need to test its fixtures for lead.

Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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: CHIBI CHAN TOO	FACILITY NUMBER: 384002962
	VISIT DATE: 06/26/2024

NARRATIVE

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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 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).

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/.

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.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

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: CHIBI CHAN TOO	FACILITY NUMBER: 384002962
	VISIT DATE: 06/26/2024

NARRATIVE

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See LIC809-D for deficiency cited today regarding criminal record clearance. Appeal rights were provided and explained to D2. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Shoshana Kanzaki.

LPA Tse informed facility representative Shoshana Kanzaki that this report dated 6/26/2024 documents one Type A citation which shall be posted for 30 consecutive days as there was immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Tse informed the facility representative to provide a copy of this licensing report dated 6/26/2024 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.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/26/2024 11:47 AM - It Cannot Be Edited

Created By: Jonathan Tse On 06/26/2024 at 11:14 AM

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: CHIBI CHAN TOO	FACILITY NUMBER: 384002962
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in one out of seven staff members which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/27/2024
	Plan of Correction
1 2 3 4	S4 was associated to the facility on this day, 6/26/2024. Licensee shall sign up for a Guardian account to associate staff members to the facility and provide proof to LPA via email.

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:

Ali Zebila

LICENSING EVALUATOR NAME:

Jonathan Tse

LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024

LIC809 (FAS) - (06/04)

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