384004747-9-18-2024-05-CC-LGOZ-D98R5B-20240918124253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004747
Report Date: 09/18/2024
Date Signed: 09/18/2024 12:43:03 PM

Document Has Been Signed on 09/18/2024 12:43 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:	MOLDOVAN ACADEMY		FACILITY NUMBER:	384004747
ADMINISTRATOR/ DIRECTOR:	NAVARRO, DARLENE		FACILITY TYPE:	850
ADDRESS:	1650 VALENCIA STREET		TELEPHONE:	(707) 337-2874
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 49	TOTAL ENROLLED CHILDREN: 49	CENSUS: 17	DATE:	09/18/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:40 AM
MET WITH:	Darlene Navarro		TIME VISIT/ INSPECTION COMPLETED:	12:50 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 9/18/2024 at 8:40AM., Licensing Program Analyst (LPA), Luis Gomez met with Director, Darlene Navarro. The purpose of today's visit was explained and was for an unannounced, annual random inspection. Present was Director and 5 staff supervising 17 children. LPA reminded director to ensure children present are signed-in by guardians. Program is a preschool with toddler option. Days and hours of operation are Monday- Friday, 8:00AM- 6:00PM. Program utilizes three classrooms: Classroom #1 (Toddler), 1.5- 2 years old; Classroom #2 (Toddler), 2-3 years old; and Classroom #4 (Preschool), 3-5 years old. Per Director, classroom #3 is not currently in use. Program utilizes one, shared, Outdoor Play Area. Outdoor play schedule was observe posted next to license. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 8:45AM., LPA observed the following: Classrooms were clean, neat, with age-appropriate materials and playthings available for the children. Each classroom has several activity areas including Reading Area, Dramatic Play and Art Stations. Classrooms are equipped with several tables, chairs, and furniture scaled to the appropriate size. Accessible objects and supplies were free of sharp corners or splinters. Children’s cubbies are available for storage of belongings. The off-limit areas have been made inaccessible. The children’s bathrooms were observed clean with toilets and faucets in operating condition. The toddler classrooms have diaper changing table, is within arms reach of a sink. Facility has extra cabinets available for added storage. Classrooms have adequate lighting; and were a comfortable temperature for the children. LPA reminded director to ensure classrooms have sufficient ventilation. Facility had a functioning telephone service; carbon monoxide detector; and fire extinguisher (2A10BC). Per director, smoke detector is build into the building. LPA observed trash bins used for solid waste had been covered. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

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 09/18/2024 12:43 PM - It Cannot Be Edited

Created By: Luis Gomez On 09/18/2024 at 11:23 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: MOLDOVAN ACADEMY	FACILITY NUMBER: 384004747
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 11:25AM., Based on record review, LPA confirmed staff do not have their current cardiopulmonary resuscitation/ first aid certification on file. This poses a potential health and safety risk to children in care.
	POC Due Date: 10/02/2024
	Plan of Correction
1 2 3 4	Director will ensure staff have completed the required CPR/ 1st Aid Certification by due date: 10/02/2024. Proof of correction will be submitted to the Department 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: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

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

FACILITY NAME: MOLDOVAN ACADEMY	FACILITY NUMBER: 384004747
	VISIT DATE: 09/18/2024

NARRATIVE

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At 9:35AM, LPA reviewed the outdoor play area. LPA observed absorbent material has been installed on ground surface. Area was completely enclosed with tall fencing, with playthings in proper repair. Shaded rest area was available for the children. Climbing structure had been properly anchored.

LPA observed individual bottles readily available for children to drink water as they wish.

At 10:05AM., LPA reviewed the facility records including a sample of the children and personnel files. The personnel files reviewed contained Teacher's Proof of Qualifications; Notice of Employee Rights (LIC9052); Mandated Reporter Training Certification (AB1207); and Acknowledgement to Report Suspected Child Abuse (LIC9108).

At 10:45AM., Based on record review, LPA confirmed staff's proof of immunization missing from the facility records. Advisory Note: Technical Violation (LIC9102TV) was issued.

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

11:20AM., Based on record review, LPA confirmed staff are not documenting infant napping conditions during each 15 minute review. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 11:25AM., Based on record review, LPA confirmed staff do not have their current cardiopulmonary resuscitation/ first aid certification on file.
Emergency disaster drills are done every six months, with last drill completed on 6/11/2024, properly logged.

Required postings in facility and included the: Facility License; Notification of Parent’s Rights (PUB394); Personal Rights (LIC613A); The Passenger Safety Laws Form (PUB269); and Emergency Disaster Plan (LIC610).

The children’s medication and pertaining documents were reviewed during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC809 (FAS) - (06/04)

Page: 5 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: MOLDOVAN ACADEMY	FACILITY NUMBER: 384004747
	VISIT DATE: 09/18/2024

NARRATIVE

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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/.

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 including plan for correction, and facility evaluation report was discussed with Director, Darlene Navarro. Staff’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: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC809 (FAS) - (06/04)

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