384004299-10-17-2022-05-CC-LTMO-CJ8SNN-20220913140150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004299
Report Date: 09/13/2022
Date Signed: 10/17/2022 01:14:58 PM

Document Has Been Signed on 10/17/2022 01:14 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: 10	CENSUS: 6	DATE:	09/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Director, Barbara Simons		TIME COMPLETED:	02:30 PM

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	On September 13th, 2022 at approximately 1PM, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, annual, required inspection. LPA met with Director, Barbara Simons and explained the purpose of the inspection. Present in the facility are Director and 2 staff caring for a total of 6 preschool age children. All adults working in the facility are fingerprint cleared. Facility is currently operating within teacher to child ratio on this date. Facility is associated with Sts. Peter and Paul Elementary school. Facility operated in the Polar Bears/Prek-3s Classroom and outside yard. Facility operates from Monday-Friday from 8am-5:30pm. LPA observed classroom to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located outside the classroom labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system inside the classroom as well as a fully charged, fire extinguisher. The classroom has a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information. Medication is stored appropriately, inaccessible to enrolled children and maintained with proper documentation. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility high shelves. Facility has children bring snacks and lunch themselves. Children bring water bottles that are brought by the children. Filtered water is available to children indoors and outdoors. Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Children are signed in and out of facility with parents' signatures through the brightwheel app. Facility has license documentation and information properly posted and available for review. LPA reviewed facility records that included 7 children's records and 3 staff records. LPA observed children's and staff's records to be complete. At least one staff have an up to date CPR & First Aid certificate. Staff will update their Mandated Reporter Certificate. Last emergency drill was conducted 05/2022. Emergency drills are conducted at least once every six months and are properly logged and documented. Continued on Page 2..

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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: STS. PETER AND PAUL-LAURA VICUNA PRE-KINDERGARTEN	FACILITY NUMBER: 384004299
	VISIT DATE: 09/13/2022

NARRATIVE

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Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Directors were 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.

This facility is providing Incidental Medical Services – IMS. Facility currently does have any children enrolled that use IMS and will work on developing a written plan. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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: http://www.ada.gov/childqanda.htm

Based on today's inspection, deficiencies were not observed, according to California Title 22, Health and Safety Code of Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Barbara Simons.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC809 (FAS) - (06/04)

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