384004296-3-27-2023-05-CC-LGOZ-CQBPXL-20230327114231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004296
Report Date: 03/27/2023
Date Signed: 03/27/2023 11:42:45 AM

Document Has Been Signed on 03/27/2023 11:42 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MIO-PRESCHOOL		FACILITY NUMBER:	384004296
ADMINISTRATOR:	CANDICE CACERAS		FACILITY TYPE:	850
ADDRESS:	2235 MISSION STREET		TELEPHONE:	(415) 655-3756
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 15	CENSUS: 13	DATE:	03/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Marisela Pelayo, Candice Caceras		TIME COMPLETED:	11:55 PM

NARRATIVE

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On 3/27/2023 at 09:00AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Teacher, Marisela Pelayo. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Director, Candice Caceras arrived during inspection. Facility is licensed to operate preschool-age program. Present was the directors and 2 staff supervising 13 children. Staff have criminal record clearances on file. Program utilizes one classroom. Days and hours of operation are: Monday- Friday, 7:30AM.,- 5:30PM, and operated year-round. Facility was inspected for health and safety hazards.

At 9:05AM., LPA observed the following: Classroom was clean, orderly, with age-appropriate playthings available to the children. Floors and ground surfaces were free of any obstructions or potential hazards. Labeled cubbies are available for storage of child’s belongings. Classroom has been separated into several different activity areas. Accessible books, materials and furniture inspected were free of sharp corners or splinters. Staircase has been made inaccessible. Classroom was equipped with child- sized tables and chairs.

At 9:25AM., Based on observations, LPA confirmed several children's chairs have dirt buildup. Advisory Note: Technical Assistance (LIC9102TA) was issued.

Children’s bathroom was maintained clean with supplies for handwashing. Fixtures tested were in operating condition. Staff bathroom is located separate. For napping services, foldable mats are stored in facility. Per director, supplies are washed weekly by families. Facility was the proper temperature, with ventilation and lighting. Disinfectants, cleaning solutions, poisons and other hazardous items have been stored inaccessible to children. Facility has functioning smoke/ carbon monoxide combination detector, on-site telephone service, and two fully charged fire extinguishers: 2A:10BC. First aid kit was reviewed and is fully stocked.

Per director, for outside play, children are taken to community park located at: 850 Valencia Street, San Francisco, CA 94110. Outdoor waiver was observed posting in lobby.

(REFER TO 809C FOR CONT.)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MIO-PRESCHOOL	FACILITY NUMBER: 384004296
	VISIT DATE: 03/27/2023

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(Page 2)
At 9:50AM LPA reviewed facility records including five children’s files and two personnel files. Staff files contained the: Notice of Employee Rights (LIC9052); Education Verification; Updated ‘Mandated Reporter Training’ certification (AB1207); and Personnel Record (LIC501).

LPA reminded director to ensure staff's proof of immunization are stored in facility files. Advisory Note: Technical Violation (LIC9102TV) was issued.

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

Staff member had their current ‘Cardiopulmonary Resuscitation and First Aid’ certification, which expires on: 5/18/2024.

Emergency disaster drills are conducted every six months with the last drill completed on, 3/17/2023, properly logged.

In lobby, LPA observed required posting including: Facility License; Notice of Parent’s Rights (PUB394); Emergency Disaster Plan (LIC610); Emergency Preparedness Checklist (LIC9148) and Seat Belt Safety Laws (PUB269)

Per director, authorized representatives provide all food and snack services.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MIO-PRESCHOOL	FACILITY NUMBER: 384004296
	VISIT DATE: 03/27/2023

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(Page 3)
Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations. Exit interview and Report was reviewed with Director, Candice Caceras, and signature of this form acknowledges receipt of these documents.

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

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC809 (FAS) - (06/04)

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