384004459-11-12-2024-05-CC-LGOZ-DAXSGS-20241112125224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004459
Report Date: 11/12/2024
Date Signed: 11/12/2024 12:52:35 PM

Document Has Been Signed on 11/12/2024 12:52 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/ DIRECTOR:	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: 11	DATE:	11/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Cristina Ponce		TIME VISIT/ INSPECTION COMPLETED:	01:10 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 11/12/2024 at 8:45AM., Licensing Program Analyst (LPA), Luis Gomez met with Director, Cristina Ponce. The purpose of today's visit was explained and was for an unannounced, annual random inspection. This facility is licensed to operate a preschool- age program. Present was the director and 3 staff supervising 11 children. Adults in facility have criminal record clearances on file. Facility is maintaining daily sign-in, sign-out sheet. Days and hours of operation are Monday- Friday, 8:30AM-3:30PM. Program operates on a 10- month school year calendar. Per director, Wednesday are early dismissal with pick-up at 1:00PM. Program utilizes two rooms: Multi-Purpose/ Gym Room; Classroom #1; and an Outdoor Play Area. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 8:50AM., LPA observed the following: Facility was clean, neat, with age-appropriate materials and playthings available for the children. Floor and ground surfaces were clear of obstruction or hazards. Child safety gates have been installed, preventing assess to off-limit areas. Accessible class furniture and equipment was free of sharp corners or splinters. Per director, gym room equipment including tumbling mats and climbing boxes are disinfected by staff.

LPA advised director to secure electrical box on gym room wall, near the sensory swing. Advisory Note: Technical Violation (LIC9102TV) was issued.

LPA observed tables, chairs, and furniture is scaled to the appropriate size and in good repair. Individual cubbies are in entry way, for storage of children’s belongings. The children’s bathrooms were clean, with toilet and faucet in operating condition. Diaper changing table is available for staff as needed.

For rest/ napping services, facility has plastic cots available for each child in care. Per director, blankets and linens are washed weekly. Facility has proper ventilation, adequate lighting, and a comfortable temperature. Facility had a functioning telephone service and fire extinguishers (2A10BC). Functioning carbon monoxide detector was tested during inspection. Facility toxins, cleaning detergents, and compounds have been stored in the off-limit areas.

Facility’s food preparation/ storage area was free of liter or rubbish. LPA observed all trash bins for solid waste have been covered. Water from non-contaminated outlets is available for children to drink water as they wish. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 6

Document Has Been Signed on 11/12/2024 12:52 PM - It Cannot Be Edited

Created By: Luis Gomez On 11/12/2024 at 11:10 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: PROJECT COMMOTION-LAS LUCIERNAGAS	FACILITY NUMBER: 384004459
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 10:45AM., Based on interview and record review, LPA confirmed facility has not conducted emergency disaster drill in last six month. This poses a potential health and safety risk to children in care.
	POC Due Date: 11/15/2024
	Plan of Correction
1 2 3 4	Director will conducted and document emergency disaster drill by the due date 11/15/2024. Proof of correction will be submitted to LPA via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: 11/12/2024

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
26
27
28
29
30
31
32

(Page 2)
At 9:30AM, LPA reviewed the outside play area. Per director, outdoor area is setup prior to use. Absorbent padding is been installed on floor for added safety. Areas were completely enclosed with tall fencing and playthings in like-new condition.

At 9:55AM., LPA reviewed facility records including a sample of the 4 children and 4 personnel files. The personnel files reviewed contained: Teacher Qualifications; Notice of Employee Rights (LIC9052); proof of mandated reporter training course (AB1207); and Acknowledgement to Report Suspected Child Abuse (LIC9108).

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

Director’s cardiopulmonary resuscitation certification (CPR) pediatric first aid certification was current, expiring on: 3/2025.

At 10:45AM., Based on interview and record review, LPA confirmed facility has not conducted emergency disaster drill in last six month.

Required postings in lobby and included the: Facility License; Notification of Parent’s Rights (PUB394); Personal Rights (LIC613A); The Passenger Safety Laws Form (PUB269); Emergency Disaster Plan (LIC610). Outdoor space waiver for rotational use of outdoor space was observed posted.

LPA reminded director food service menus must be current and posted in visible location. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: 11/12/2024

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
26
27
28
29
30
31
32

(PAGE 3)
Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed childcare centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN21-21- CCP.

Incidental Medical Services (IMS) policy was discussed with director. For information regarding IMS, please 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/.

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 Chap. 1 Ca. Code of Regulations and cited on 809D. An exit interview, plan for correction, and facility evaluation report was discussed with Director, Cristina Ponce. Director’s signature on this form acknowledges receipt of these documents.

This report must be made available in facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director was advised, any additional questions/ concerns to contact the office, M-F, 8:00am-5:00pm, 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: 11/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6