384002978-1-28-2025-05-CC-LGOZ-DDD24D-20250128160346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002978
Report Date: 01/28/2025
Date Signed: 01/28/2025 04:03:58 PM

Document Has Been Signed on 01/28/2025 04:03 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:	PETITE EXPLORER PRESCHOOL		FACILITY NUMBER:	384002978
ADMINISTRATOR/ DIRECTOR:	LAM, VICTORIA		FACILITY TYPE:	850
ADDRESS:	722 SOUTH VAN NESS		TELEPHONE:	(415) 872-9185
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 66	TOTAL ENROLLED CHILDREN: 66	CENSUS: 47	DATE:	01/28/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:55 AM
MET WITH:	Victoria Lam, Andy Wong		TIME VISIT/ INSPECTION COMPLETED:	04:15 PM

NARRATIVE

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On 1/28/2025 at 11:55AM., Licensing Program Analyst (LPA), Luis Gomez met with Director, Victoria Lam. The purpose of today's visit was explained and was for an unannounced, annual random inspection. This facility is licensed to operate a preschool-age program. Present was Director and 10 staff supervising 47 children. The days and hours of operation are Monday- Friday, 8:00AM- 5:30PM., Staff in facility have criminal record clearances on file. Children present had been signed-in by guardians. Program utilizes four classrooms: Discover Room, 3-4 years old; Explorer Room, 4-5 years old; Petite Explorer, 2 year old; Wonder Room, 2 year old and two, shared, outside play areas. LPA observed approved waiver, for rotational use of outdoor space posted in facility. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 12:00PM., LPA observed the following: Classrooms were clean, neat, with age-appropriate materials and playthings available for the children. Floors and walkways were clear of hazards leading to the exits. Classrooms were equipped with several tables, chairs, and labeled cubbies for storage of belongings. LPA advised director to ensure the children’s items do not come in contact with each other.

All furniture inspected was scaled to the appropriate size. Safety locks have been installed on windows. The children’s bathrooms were clean with available supplies for handwashing. Toilets and faucets inspected were in operating condition. Facility had extra drawers and cabinets for added storage.

For scheduled rest/ nap services, LPA observed plastic covered mat available. Per director, blankets and supplies are washed weekly by families.

The kitchen/ storage areas were free of any liter/ rubbish, with all food items reviewed current and properly stored. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

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 5

Document Has Been Signed on 01/28/2025 04:03 PM - It Cannot Be Edited

Created By: Luis Gomez On 01/28/2025 at 03:00 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: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:50PM., Based on record review, LPA confirmed staff proof of immunization missing from facility records. This poses a potential health and safety risk to children in care.
	POC Due Date: 02/28/2025
	Plan of Correction
1 2 3 4	Facility will ensure staff proof of required immunization are stored in facility record by due date: 2/28/2025. Proof of correction will be submitted to the Department 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:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
	VISIT DATE: 01/28/2025

NARRATIVE

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(Page 2)
Facility has ventilation; lighting; and was a comfortable temperature. Facility had a functioning telephone service and fire extinguishers (2A10BC) and testable carbon monoxide detector.

At 12:40PM, LPA reviewed the outside play area #1, #2. LPA observed absorbent rubber padding /turf installed around climbing structure. Area was completely enclosed with available shading available. Sandbox area was free of foreign objects.

LPA observed available water served from refillable bottle for children to drink as they wish.

At 1:05PM., LPA reviewed facility records including a sample of the children files and personnel files. The personnel files reviewed contained Teacher's Proof of Qualifications; Notice of Employee Rights (LIC9052); Acknowledgement to Report Suspected Child Abuse (LIC9108); and Personnel Record.

LPA reminded facility to ensure staff's proof of completed mandated reporter training certifications (AB1207) are stored in facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 1:50PM., Based on record review, LPA confirmed staff proof of immunization missing from facility records.

Children’s files were reviewed and contained the: Identification and Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Consent for Emergency Medical Treatment (LIC627); Immunization Record; and Personal Rights (LIC613A).

Staff's Cardiopulmonary Resuscitation / First Aid certification was current, expiring on: 1/2027.

Facility emergency disaster drill (Fire and Earthquake) was completed in selected classrooms on: 1/14/2025, 1/18/2025.

Required postings including the: Facility License; Notification of Parent’s Rights (PUB394); Personal Rights (LIC613A); The Passenger Safety Laws (PUB269); Outdoor Space Waiver; Menu (January, 2025); and Emergency Disaster Plan (LIC610). (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: PETITE EXPLORER PRESCHOOL	FACILITY NUMBER: 384002978
	VISIT DATE: 01/28/2025

NARRATIVE

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(PAGE 3)
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. LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations and cited on 809D. An exit interview discussing facility evaluation report and plans of correction was conducted with Andy Wong. Staff's signature on this form acknowledges receipt of these documents.

This report must be made available in facility for public review. Notice of site visit was provided and must remain posted for 30 days. Teacher was advised, any additional questions/ concerns to contact the office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

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