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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384003095
Report Date: 10/22/2021
Date Signed: 10/22/2021 01:06:41 PM

Document Has Been Signed on 10/22/2021 01:06 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:CITY SPROUTS PRESCHOOLFACILITY NUMBER:
384003095
ADMINISTRATOR:CULLINAN, REBECCAFACILITY TYPE:
850
ADDRESS:1466 38TH AVETELEPHONE:
(415) 971-1394
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 15TOTAL ENROLLED CHILDREN: 20CENSUS: 17DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rebecca CullinanTIME COMPLETED:
12:30 PM
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On October 22, 2021, at approximately 9:30am, Licensing Program Analyst (LPA) Winnie Ly conducted an Unannounced Required-1 Year Visit at and met with Site Director, Rebecca Cullinan during the visit. Purpose of the inspection was explained. There are 17 children 4 staff members present during visit. The center uses an electronic sign in/out system using an Ipad. All children were signed into the system.

Facility has 2 children more than licensed capacity. This poses a potential risk to children in care. Facility has an increase of capacity request on file. Therefore Type B is being cited in accordance with the California Code of Regulations, Title 22, see LIC 809D.

LPA and Site Director inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Per the Site Director, there are no firearms or weapons in the center. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in locked drawer inaccessible to children. .

Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. The food prep area is clean and orderly. The center provides snacks and has a vendor lunch. Menus are posted in the center. All solid waste storage containers have tight fitting lids. Drinking water is provided indoor and outdoor by cups and/or water bottles.

LPA and Site Director also toured the outdoor play area for Health and Safety Hazards. LPA observed outdoor equipment is in good condition, free from loose, sharp or pointed parts. The play structure appears to be age appropriate for children in care. Areas under slides and other climbing equipment is adequately cushioned. Last Emergency Drill was conducted on 10/02/2021 and properly logged. A random sample of children's were reviewed and found to be complete.

CONTINUED>>>
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CITY SPROUTS PRESCHOOL
FACILITY NUMBER: 384003095
VISIT DATE: 10/22/2021
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At 10:45am, LPA reviewed staff files and staff files are incomplete. This poses a potential risk to children in care. Therefore Type B is being cited in accordance with the California Code of Regulations, Title 22, see LIC 809D. .

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 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

Facility was also 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.

LPA discussed Child Abuse Mandated Training AB1207 with the Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

An exit interview was conducted and Plans of Corrections (POC) were developed and reviewed with Licensee. A copy of this report and appeal rights were discussed and will be emailed to Director whose signature on this form confirm have read of these reports.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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Document Has Been Signed on 10/22/2021 01:06 PM - It Cannot Be Edited


Created By: Winnie Ly On 10/22/2021 at 11:47 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: CITY SPROUTS PRESCHOOL
FACILITY NUMBER: 384003095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2021
Plan of Correction
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Director will collect all required documentations from staff to maintian a complete file for each staff present at facility. Director will email proof to LPA or follow up visit will be conducted.
Type B
Section Cited
CCR
101216.3(a)(1)
Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. (1) The number of children in attendance shall not exceed licensed capacity.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2021
Plan of Correction
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Director will work to make sure she does not enroll children more than license capacity.

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:Winnie Ly
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2021


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