384004684-5-17-2024-05-CC-WLYY-D5CT57-20240517142501

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004684
Report Date: 05/17/2024
Date Signed: 05/17/2024 03:18:08 PM

Document Has Been Signed on 05/17/2024 03:18 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	COW HOLLOW SCHOOL		FACILITY NUMBER:	384004684
ADMINISTRATOR:	CAMPBELL, DARCY		FACILITY TYPE:	850
ADDRESS:	387 MORAGA AVENUE		TELEPHONE:	(415) 921-2328
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94129
CAPACITY:	150	CENSUS: 115	DATE:	05/17/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Darcy Campbell		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 May 17, 2024 at approximately 11:00am, Licensing Program Analysts (LPAs) Ly and Basak conducted an Unannounced Annual Visit and met with Executive Director, Darcy Campbell during the visit. Purpose of the inspection was explained. Present during today’s visit were 25 staff including the Executive Director caring for 115 children. Teacher to child ratios were met on this day. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. Facility uses clipboard for parents to sign their children in and out of the program. LPAs and Site Director inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Adequate first aid supplies are available. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in the office inaccessible to children. LPAs reviewed medication procedures with staff. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. The center provides morning and afternoon snacks. Menus are posted in the center. All solid waste storage containers have tight fitting lids. Drinking water is provided indoor and outdoor by water fountain, water pitchers and children individual water bottles. LPAs and Site Director also toured the outdoor play area for Health and Safety Hazards. LPAs observed outdoor equipment is in good condition, free from loose, sharp or pointed parts. The play structure appears to be age appropriate for children in care. Last Emergency Drill was conducted on 02/29/2024 and properly logged. At 1:40pm, LPAs inspected children's medication. LPAs found 4 children's Epinephrine Injections has been expired. Expired medication poses a potential health and safety risk to children in care. Type B deficiency has been issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D. CONTINUED>>>...PAGE 2...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COW HOLLOW SCHOOL	FACILITY NUMBER: 384004684
	VISIT DATE: 05/17/2024

NARRATIVE

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A random sample of children's and staff’s files were reviewed and found to be complete. At least one staff have current Pediatric First Aid and CPR. Facility has posted all the required licensing forms in a prominent visible location.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility Representative was reminded that all adults 18 and over, 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPAs verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

CONTINUED>>>...PAGE 3...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COW HOLLOW SCHOOL	FACILITY NUMBER: 384004684
	VISIT DATE: 05/17/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Facility was also 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.

LPAs discussed Child Abuse Mandated Training AB1207 with the Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

An exit interview was conducted and Plans of Corrections (POC) were developed and reviewed with the Director. A copy of this report and appeal rights were discussed and left with the Director whose signature on this form confirm receipt of these reports.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 05/17/2024 03:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COW HOLLOW SCHOOL	FACILITY NUMBER: 384004684
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(3)(A)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, 4 children's Epinephrine Injections has been expired.the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/31/2024
	Plan of Correction
1 2 3 4	Facility Representative will ask parents to bring in new medication. Picture of new medication will be taken as proof and email it to Licensing by due date 05/31/2024.

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC809 (FAS) - (06/04)

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