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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004156
Report Date: 08/19/2024
Date Signed: 08/19/2024 12:01:00 PM

Document Has Been Signed on 08/19/2024 12:01 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:POTASH, CHAYA M.FACILITY NUMBER:
384004156
ADMINISTRATOR/
DIRECTOR:		POTASH, CHAYA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 797-7231
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
08/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Licensee, Chaya PotashTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 8/19/2024, at approximately 10:30AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Chaya Potash, and explained the purpose of the visit. Present during the visit was Licensee, Licensee's spouse, two helpers, six preschool age children, and two infants. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:45AM to 4:00PM.

Daycare areas: Two living rooms, Deck and one Bathroom.
Off Limit areas: Kitchen, three Bedrooms, and hallway used for pass-through only.

LPA and Licensee inspected the home for any health or safety hazards. LPA observed the home to be in clean and orderly condition. There is a fully charged fire extinguisher that is at least size 2A10BC. There are smoke and carbon monoxide detectors present in the facility. Electrical outlets are covered or obstructed by furniture when not in use to be inaccessible to children in care. Stairs are barricaded to be inaccessible.

LPA observed there to be age-appropriate toys and learning materials. Furniture was observed to be age-appropriate and free of rough or sharp edges. Per Licensee, the facility provides snacks and lunch for children in care. Children bring water bottles from home and the facility refills the bottles as needed. Children nap on mats that are cleaned as needed. There is a first aid kit present in the Living Room that was observed to be fully stocked. Per Licensee, the second living room is currently not in use due to renovations.

LPA observed the Deck to be free of debris and other loose articles. There are age-appropriate toys and equipment available for children in care. There is cushioning available in the form of mats. The Deck is enclosed by a fence that is at least four feet high. Per Licensee, children are taken to Grattan Playground for outdoor play once a day. The playground is within walking distance of the facility. There are no swimming pools present in the facility.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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 3
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: POTASH, CHAYA M.
FACILITY NUMBER: 384004156
VISIT DATE: 08/19/2024
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LPA reviewed three staff files, six children’s files, and facility records. Licensee’s First Aid/CPR training is current and expires 7/2025. Licensee’s Mandated Reporter Training is current and expires 8/2025. LPA observed all staff to have current Mandated Reporter Training and immunization records available for review. LPA observed children’s files to be complete. All required postings were observed to be posted and accessible for review upon entry to the facility. The facility last conducted an emergency drill in 2/2024 and is due for a drill in 8/2024. Drills are properly logged and documented.

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.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: POTASH, CHAYA M.
FACILITY NUMBER: 384004156
VISIT DATE: 08/19/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

Licensee 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.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
No deficiencies were cited during today’s visit on 8/19/2024. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Chaya Potash.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
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