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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004296
Report Date: 06/11/2024
Date Signed: 06/11/2024 12:07:13 PM

Document Has Been Signed on 06/11/2024 12:07 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:MIO-PRESCHOOLFACILITY NUMBER:
384004296
ADMINISTRATOR/
DIRECTOR:		CANDICE CACERASFACILITY TYPE:
850
ADDRESS:2235 MISSION STREETTELEPHONE:
(415) 655-3756
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 15; 15TOTAL ENROLLED CHILDREN: 15CENSUS: 18DATE:
06/11/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Maricela Pelayo, Candice CacerasTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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On 6/11/2024 at 8:40AM., Licensing Program Analyst (LPA), Luis Gomez met with Lead Teacher, Marciela Pelayo. The purpose of today's inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed preschool program. Director, Candice Caceras arrived during inspection. Present was the director and 2 staff supervising 18 children. Children present have been signed in by Guardians. Staff have criminal record clearances on file. The preschool program utilizes one, shared classroom space. Waiver for use of off-site outdoor play space was observed posted in lobby. LPA inspected this facility for health and safety hazards.

At 8:50AM., Based on observation, record review, and interview, LPA confirmed facility operating beyond capacity limits stated on license with 18 children in care.
At 8:55AM., LPA observed the following: Classroom was clean and neat, with age-appropriate materials and supplies available for the children.

Walkways and ground surfaces were clear of any obstructions or hazards. The children tables and chairs, scaled to the proper size. For storage, children’s cubbies are available in entry way. The children’s bathroom area was observed clean, with fixtures in operating condition. Staircase to the 2nd level had been barricaded. For solid waste, trash bins are available with tight-fitting lids. Electrical outlets had coverings installed.

At 9:16AM., Based on observation, LPA confirmed connected kitchen appliances, accessible to children in care.

For scheduled rest/ napping services, the facility has cleanable plastic mats. Per staff, napping sheets and blankets are washed every Friday. The classroom had adequate ventilation, lighting, and was a comfortable temperature. Facility has a functioning telephone service; smoke/carbon monoxide (CO) combination detector; and fire extinguishers: 3-A:40B:C. The cleaning compounds, detergents, medications, and other items which could pose a danger have been stored inaccessible to children. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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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Document Has Been Signed on 06/11/2024 12:07 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/11/2024 at 10:29 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: MIO-PRESCHOOL
FACILITY NUMBER: 384004296

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 9:16AM., Based on observation, LPA confirmed connected kitchen appliances, accessible to children in care. This poses a potential health and safety risk to children in care.
POC Due Date: 06/14/2024
Plan of Correction
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Director will remove all accessible kitchen appliances from classroom area by the due date: 6/14/2024. Proof of correction will be submitted to LPA via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


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Document Has Been Signed on 06/11/2024 12:07 PM - It Cannot Be Edited


Created By: Luis Gomez On 06/11/2024 at 10:38 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: MIO-PRESCHOOL
FACILITY NUMBER: 384004296

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101161(a)
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 8:50AM., Based on observation, record review, and interview, LPA confirmed facility operating beyond capacity limits stated on license with 18 children in care. This poses an immediate health and safety risk to children in care.
POC Due Date: 06/12/2024
Plan of Correction
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Director will reduce enrollment to required capacity limits and submit updated children roster (LIC9040) to the Department by due date: 6/12/2024.

Guardians will sign the LIC9224, 'Notice of A type deficiency' to be stored in children's files.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


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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: MIO-PRESCHOOL
FACILITY NUMBER: 384004296
VISIT DATE: 06/11/2024
NARRATIVE
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Per director for outside play, children are taken to the local park at 850 Valencia Street, San Francisco, CA 94110. Waiver was observed posted in lobby.

The food preparation/ storage areas were reviewed during inspection. Per director, families provide lunches and facility gives snacks (morning, afternoon). Food items inspected were current.

At 9:50AM., LPA reviewed facility records including children and personnel files. The personnel files were reviewed and contained staff’s Proof of Teacher Qualifications; Proof of required immunization; Notice of Employee Rights (LIC9052); Acknowledgement to Report Suspected Child Abuse (LIC9108); Personnel Record; and Mandated Reporter Training (AB1207) certificate.

Children files were reviewed and contained the: Consent for Emergency Medical Treatment; Immunization Records; Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

LPA reminded director children's medical assessments must completed and stored in facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

Staff’s Cardiopulmonary Resuscitation / First Aid certification was current and expires on: 4/2025.


Facility is conducted required emergency disaster drills every six months, with last drill (Fire Drill) completed on: 2/11/2024.

LPA observed required postings including the: License; Notification of Parent’s Rights (PUB394); Passenger Safety Laws (PUB269); and Emergency Disaster Plan (LIC610).

Facility reminded to post snack menu for families at least one week in advance. Advisory Note: Technical Violation (LIC9102TV) was issued. (REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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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: MIO-PRESCHOOL
FACILITY NUMBER: 384004296
VISIT DATE: 06/11/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

LPA referred Director to the Department website regarding Lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chapter 1 Ca. Code of Regulations, cited on 809D. Exit interview reviewed the facility evaluation report, and plans for correction was discussed with Director, Candice Caceras. Administrator’s signature on this form acknowledges receipt of these documents.



Facility was issued Type “A” violation and was advised to provide a copy of the ‘Facility Evaluation Report’ and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months.
All signed LIC 9224, ‘Deficiency and Acknowledgment of Receipt of Licensing Reports; shall be maintained in the children's files.

This report must be made available in facility for public review. Notice of site visit was given and must remain posted for 30 days. Staff was advised, any additional questions/ concerns to contact the office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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