384004459-9-13-2023-05-CC-LGOZ-CVMQUM-20230913122855

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004459
Report Date: 09/13/2023
Date Signed: 09/13/2023 12:29:04 PM

Document Has Been Signed on 09/13/2023 12:29 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:	PROJECT COMMOTION-LAS LUCIERNAGAS		FACILITY NUMBER:	384004459
ADMINISTRATOR:	OSTERHOFF, SUSAN		FACILITY TYPE:	850
ADDRESS:	2095 HARRISON STREET		TELEPHONE:	(415) 252-8059
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 6	DATE:	09/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Cristina Ponce		TIME COMPLETED:	12:35 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 9/13/2023 at 8:55AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Lead Teacher, Cristina Ponce. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate preschool-age program. Present during inspection was the lead teacher and 3 staff supervising 6 children. Children present had been properly signed in. Personnel have criminal record clearances on-file. Program utilizes two rooms, Multi-Purpose/ Gym Room; Classroom #1; and one Outdoor Play Area. Program operates on a 10- month school year calendar. Day and hours of operation are Monday- Thursday, 8:30AM-3:30PM; and Friday, 8:30AM- 1:00PM. LPA inspected facility indoors and outdoors with lead teacher for health and safety hazards. At 9:00AM., LPA observed the following: Facility was clean and orderly, with age-appropriate playthings available for the children. Floor/ground surfaces were free of any obstructions or hazards. Cubbies are available for storage of belongings. Accessible furniture, books, and supplies were in good repair. Toys inspected were free of sharp corners or splinters. Facility is equipped with child- sized tables and chairs for seated activities. Children’s bathrooms are maintained clean, with fixtures in operating condition. Changing table is available for staff. Per lead teacher, changing mat is disinfected after each use. Staff bathroom is located separate. For napping services, stackable cots are available. LPA observed napping cots made of cleanable material. Per lead teacher, napping sheets are washed weekly. Facility has acceptable ventilation and lighting. Disinfectants, toxins, and cleaning compounds have been stored inaccessible to children. Electrical outlets and trash bins in classrooms have coverings installed. Per Lead Teacher, smoke/ carbon monoxide detectors (Built-In) are functioning. Facility has functioning telephone service and several fully charged fire extinguishers: 2A:10BC. First aid kit reviewed is fully stocked. At 9:35AM, LPA inspected facility’s outdoor play area. Area was completely enclosed with absorbent padding installed for added safety. Shaded resting area with water services is available for children. Outside playthings inspected were in proper repair. LPA reviewed facility’s food preparation/storage area. Food items inspected had been properly stored. Area was observed clean, free of trash or rubbish and made inaccessible with child safety gate. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PROJECT COMMOTION-LAS LUCIERNAGAS	FACILITY NUMBER: 384004459
	VISIT DATE: 09/13/2023

NARRATIVE

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(Page 2)
At 9:45AM LPA reviewed facility records including 5 children’s files and 5 personnel files. Staff’s files contained the: Notice of Employee Rights (LIC9052); Education Verification; Personnel Record (LIC501); and Updated Mandated Reporter Training Certification (AB1207).

LPA reminded lead teacher to ensure staff’s proof of required immunization are stored in the facility files. Advisory Note: Technical Assistance (LIC9102TA) was issued.

Lead Teacher’s ‘Cardiopulmonary Resuscitation and First Aid’ certifications was current, expiring on: 3/11/2025.

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

Per lead teacher, the emergency disaster drill is conducted monthly with last drill logged on: 9/3/2023.

LPA observed required posting in entry way, including the License; Emergency Disaster Plan (LIC610); Snack Menu (September); Notification of Parent’s Rights (PUB394); and Child Passenger Safety Laws (PUB369).

CCC Completed testing with no lead exceedances.

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/.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PROJECT COMMOTION-LAS LUCIERNAGAS	FACILITY NUMBER: 384004459
	VISIT DATE: 09/13/2023

NARRATIVE

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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.

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 Lead Teacher, Cristina Ponce, and signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director 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: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC809 (FAS) - (06/04)

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