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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004625
Report Date: 10/06/2022
Date Signed: 10/06/2022 11:36:52 AM

Document Has Been Signed on 10/06/2022 11:36 AM - 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:C5 FOX PLAZA INFANT CENTERFACILITY NUMBER:
384004625
ADMINISTRATOR:MCGEE, ASAKOFACILITY TYPE:
830
ADDRESS:1390 MARKET STREET, SUITE 110TELEPHONE:
(415) 340-0421
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
10/06/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Beverly MeluginTIME COMPLETED:
11:45 AM
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On October 6, 2022 at 9:00 AM, Licensing Program Analysts (LPAs) Sheran Lo met with Applicant Beverly Melugin today for a pre-licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is requesting 12 children (birth to 2 years old). The facility will operate Monday - Friday; 8:00 AM to 5:30 PM. The designated director/site supervisor for the facility is Asako McGee. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: There are two classrooms that will be used for the program and the following square footage was calculated for each room: Room 1- 233.93 sq ft and Room 2- 357.59 sq ft. Total useable indoor square footage is 591.52 sq ft divided by 35 sq ft equals 16 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There is storage space for children's personal belongings and mats to be utilized for napping children. Facility will provide a sheet for children and bedding will be laundered on site. Cribs and cots will be cleaned at least weekly or more often if needed. Children will be signed in and out with a tablet to be kept in classrooms. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, separate kitchen area where snack food is stored, garbage cans with tight-fitting lids, first aid and emergency supplies. The facility is adequately ventilated and free of insects and bugs. Windows are high up inaccessible to children. The program provides two snacks and lunch catered by Chefables. Reusable and disposable products will be used for food served by the facility. Snack foods will be stored in the kitchen separately from any cleaning products or other hazards. Medications will be stored in the staff area inaccessible to the children; there is a refrigerator located in this area for refrigerated medications.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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: C5 FOX PLAZA INFANT CENTER
FACILITY NUMBER: 384004625
VISIT DATE: 10/06/2022
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There are _ 1 toilet (15 capacity) and 1 sinks (15 capacity) accessible for children's use. Bathroom/Changing Table area is next to staff area. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees. The program will provide a water dispenser and cups for children to drink water indoors. All toxins and other hazardous items will be stored in a locked cabinet in the classroom and will be inaccessible to children. Isolation of ill children will be located in the director office and a staff bathroom will be used if necessary.

Outdoor: The facility is requesting for open space waiver to use private infant outdoor space at the SFPUC C5 Children's School Infant yard that measures 1,307 sq ft enough for 17 children. The outdoor area to be used is enclosed by at least a four-foot fence and observed to be clean, safe and equipped with toys and equipment for children. Resilient material located under climbing applicable climbing structures is a pour and play soft padding. There will be individual water bottles to allow children access to drinking water outside. Shade for children will be provided by building structures and tents.

Required postings were observed during today's inspection. Facility will conduct monthly disaster drills and a log will be maintained for review upon request. The fire inspection will be conducted today, and applicant will request for a copy if passed. The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Information was provided to applicants during today's inspection. Advisory Note provided to applicants stating that the requirement for testing must be met by January 2023.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. 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
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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: C5 FOX PLAZA INFANT CENTER
FACILITY NUMBER: 384004625
VISIT DATE: 10/06/2022
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Applicant 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, 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Exit interview conducted and report was reviewed with the applicant Beverly Melugin.

Review of records to be maintained

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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 platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA Lo will recommend licensure of this facility for a capacity of 12 children once the following is received:


-FIRE CLEARANCE (STD 850)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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