384004002-9-26-2024-05-CC-JTSE-D9GSRJ-20240926140624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004002
Report Date: 09/26/2024
Date Signed: 09/26/2024 02:07:10 PM

Document Has Been Signed on 09/26/2024 02:07 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:	HAMILTON TRANSITIONAL HOUSING		FACILITY NUMBER:	384004002
ADMINISTRATOR/ DIRECTOR:	DECK-SHIPLEY, ALLISON		FACILITY TYPE:	840
ADDRESS:	1631 HAYES STREET		TELEPHONE:	(415) 321-2612
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94117
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/26/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:00 PM
MET WITH:	Director, Allison Deck-Shipley		TIME VISIT/ INSPECTION COMPLETED:	02:20 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 9/26/2024, at approximately 12:00PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Director Allison Deck-Shipley (D1) and explained the purpose of the visit. Present during the visit was D1 and two teachers. There were no children in care during the visit. The facility’s operating hours are from 1:00PM to 6:00PM. All adults working in the facility have acquired fingerprint clearance and are associated to the facility. LPA and D1 inspected the facility for any health or safety hazards. There are fully charged 2A10BC fire extinguishers present. There is a fire alarm system running throughout the facility. There are smoke and carbon monoxide detectors present. Electrical outlets are covered or obstructed by furniture when not in use. There is a functioning telephone on site. The surfaces of the floors were observed to be clean and free of debris. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. LPA observed age-appropriate toys and equipment to be present. Furniture was observed to be in good repair and free of rough or sharp edges. The facility has computers available for children to use for schoolwork. The facility provides snacks for children in care. Water is provided for children from a Brita filter. There are two bathrooms present that provide individual privacy for children. LPA observed the toilets to be operational during the visit. The facility picks children up from school before bringing them to the facility. LPA verified that all staff assigned to pick children up have current and valid Driver’s Licenses. Children are signed in upon pick-up from school, and signed in again once they arrive at the facility. There is an outdoor play area present in the facility. LPA observed it to be enclosed by a fence that is at least four feet high. There are toys and equipment available for children to use. There is resilient padding underneath a play structure. Per D1, there are no pools or other similar bodies of water present. There are no firearms or weapons stored in the facility. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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: HAMILTON TRANSITIONAL HOUSING	FACILITY NUMBER: 384004002
	VISIT DATE: 09/26/2024

NARRATIVE

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LPA reviewed three staff files, five children’s files, and facility records. All staff members present have current Pediatric First Aid/CPR training on file. All staff have immunization records and qualifications available for review. LPA observed all children’s files to be complete. LPA observed all required postings to be posted and accessible for review in the second floor play room. The facility last conducted an emergency drill on 4/24/2024. Emergency drills are properly documented and posted for review.

The facility tested its fixtures for lead on 1/13/2023, past the deadline of 1/1/2023. There were no exceedances of lead found in any of the fixtures tested. D1 was informed that a Type B deficiency would be cited and cleared during this visit. D1 stated that they understood. The facility is in compliance with lead testing requirements as of 9/26/2024. LPA advised that lead testing shall be conducted every five years.

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).

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

Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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: HAMILTON TRANSITIONAL HOUSING	FACILITY NUMBER: 384004002
	VISIT DATE: 09/26/2024

NARRATIVE

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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/.

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.

See LIC809-D for deficiency cited and cleared today regarding lead water testing. Appeal rights were provided and explained to D1. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Allison Deck-Shipley.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/26/2024 02:07 PM - It Cannot Be Edited

Created By: Jonathan Tse On 09/26/2024 at 01:53 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: HAMILTON TRANSITIONAL HOUSING	FACILITY NUMBER: 384004002
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by testing fixtures for lead after the deadline of 1/1/2023 which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	This deficiency shall be cited and cleared the same day of the visit, 9/26/2024.

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: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC809 (FAS) - (06/04)

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