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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004245
Report Date: 02/23/2022
Date Signed: 02/23/2022 11:51:06 AM

Document Has Been Signed on 02/23/2022 11:51 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ST. STEPHEN PRESCHOOLFACILITY NUMBER:
384004245
ADMINISTRATOR:KERRY O'SHAUGHNESSYFACILITY TYPE:
850
ADDRESS:473 EUCALYPTUS DRIVETELEPHONE:
(415) 682-2142
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 36TOTAL ENROLLED CHILDREN: 31CENSUS: 31DATE:
02/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kerry O'ShaughnessyTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Annual inspection. LPA met with Director Kerry O'Shaughnessy and explained purpose of inspection. The center operates on the campus of St. Stephen's Catholic School. Present at the center were the Director, three teachers, two teacher's assistants, and 31 preschool age children. Center is operating within capacity requirements and in compliance child to staff ratio. Hours of operation are Monday to Friday from 8:00am to 5:00pm.

LPA inspected center with Director. There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. Center consists of main classroom separated into two classrooms with a wall partition and third classroom in extended care room. All furniture is in good repair. The center has age appropriate toys and equipment which are in good condition in each classroom. Outdoor play area is fenced for supervision. Outdoor toys and equipment are age appropriate and in good condition.

All required postings are properly posted on the bulletin board next to the front entrance. School only provides snack for the children each day. Children bring their own lunch. Food prep area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. All cleaning products and toxins are inaccessible to children. There are two bathrooms in main classroom and one bathroom in the second classroom/extended care room. Each bathroom has one toilet and one sink and is designated for a specific classroom. There is also a separate bathroom for staff. Bathroom areas appear to be clean, in good repair, and free of any hazards.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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: ST. STEPHEN PRESCHOOL
FACILITY NUMBER: 384004245
VISIT DATE: 02/23/2022
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Ten children records reviewed were complete. All children have a record of emergency identification information on file. Six staff records reviewed were complete. All staff members have a criminal record clearance on file. Director's Pediatric First Aid/CPR certificate expires May 2023. One teacher has a Pediatric First Aid/CPR certificate which expires April 2023.

Last emergency drill was conducted on February 9, 2022. Emergency drills are conducted at least once a month in conjunction with St. Stephen's Catholic School and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone is available on-site. Phone number listed is current.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 (US DOJ) 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
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: ST. STEPHEN PRESCHOOL
FACILITY NUMBER: 384004245
VISIT DATE: 02/23/2022
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with facility representative Kerry O'Shaughnessy.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
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