384004299-10-1-2021-05-CC-GASL-C7DNRV-20211001104209

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004299
Report Date: 10/01/2021
Date Signed: 10/01/2021 08:15:25 PM

Document Has Been Signed on 10/01/2021 08:15 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	STS. PETER AND PAUL-LAURA VICUNA PRE-KINDERGARTEN		FACILITY NUMBER:	384004299
ADMINISTRATOR:	SIMONS, BARBARA		FACILITY TYPE:	850
ADDRESS:	620 FILBERT STREET		TELEPHONE:	(415) 296-8549
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94133
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 0	CENSUS: 10	DATE:	10/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Barbara Simons		TIME COMPLETED:	11:00 AM

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	An annual 1-year required inspection was conducted today. Analyst inspected the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. Licensee [or 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. OR... A review of staff records during today’s visit indicates individuals at this facility who require caregiver background checks are issued by the County Office of Education and do not come under the jurisdiction of Community Care Licensing. Days and hours of operation are: Monday through Friday 8am-3pm. The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures (smoke and carbon monoxide detectors present and in working order), Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation, Parents Rights, and Reporting Requirements.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

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: STS. PETER AND PAUL-LAURA VICUNA PRE-KINDERGARTEN	FACILITY NUMBER: 384004299
	VISIT DATE: 10/01/2021

NARRATIVE

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Posting requirements for site visits were also discussed. Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov

Director was reminded of the following:
-All staff and volunteers must have proof on file of being immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
-All staff records must include proof of completion of the required annual pesticides training. Training is available at the Department of Pesticides Regulation website at: https://apps.cdpr.ca.gov/schoolipm/childcare/training/main.cfm
-Effective July 1, 2020, Directors must have proof of completion of EMSA certified lead poison training.
-Provider Information Notices (PINs) are accessible at www.ccld.ca.gov
-Mandated Reporter Training for all staff must be renewed every two years.
-Lead Flyer Requirement, Health and Safety Code 1596.7996, mandated that effective January 1, 2019, CCCs and FCCHs are required to provide parents and guardians of children enrolling or re-enrolling in care with a Lead Poisoning Facts Flyer.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

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: STS. PETER AND PAUL-LAURA VICUNA PRE-KINDERGARTEN	FACILITY NUMBER: 384004299
	VISIT DATE: 10/01/2021

NARRATIVE

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The requirement for Lead Water Testing was discussed (H&S Code 1597.16). LPA informed the director/licensee to review Provider Information Notice 21-21-CCP (dated 7/28/21) for directives and regulations regarding obtaining a test of the water for lead, and how that information is to be documented and reported to Community Care Licensing.

LPA discussed program’s COVID-19 protocol and required postings. Applicant was informed that access to available Personal Protective Equipment (PPE) may be available through the local child care resource and referral agency.

This facility provides IMS. A review of storage of medications, equipment and supplies was conducted and LPA reviewed children, personnel and administrative records.

Report was reviewed and signed by Director, Barbara Simons. Today’s report, 10/1/21, will be sent to Barbara Simons at bsimons@sspeterpaulsf.org by close of business, 10/1/21. Confirmation of receipt is required.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Barbara Simons.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

LIC809 (FAS) - (06/04)

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