384004791-11-8-2023-05-CC-SLOO-CXDRDS-20231108115626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004791
Report Date: 11/08/2023
Date Signed: 11/08/2023 11:57:04 AM

Document Has Been Signed on 11/08/2023 11:57 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	BUILDING KIDZ ON 20TH AVENUE		FACILITY NUMBER:	384004791
ADMINISTRATOR:	XUEREB, SYLVIA		FACILITY TYPE:	850
ADDRESS:	1258 20TH AVENUE		TELEPHONE:	(415) 494-1305
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 50	CENSUS: 8	DATE:	11/08/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Sylvia Xuereb		TIME COMPLETED:	12:02 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 November 8, 2023, Licensing Program Analysts (LPA) Sheran Lo met with Applicant Sylvia Xuereb today for a pre-licensing inspection. The applicant is requesting 30 children (ages 2 years old to entry into first grade). The facility will operate Monday - Friday; 7:30 AM to 5:30 PM. The designated director/site supervisor for the facility is Michelle Palacios. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. Indoor: There are three classrooms and three Cozy Areas that will be used for the program and the following square footage was calculated for each room: Rooms 1 - 3 are 1,035 sq ft each, and the Cozy Areas are- 60 sq ft. Total useable indoor square footage is 1,095 sq ft divided by 35 sq ft equals 30 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. Families will provide their own beddings and washed at home each week. Mats will be cleaned at least weekly or more often if needed. Children will be signed in and out with an electronic 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 locked up inaccessible to children. The program provides two snacks and lunch is brought from home each day. Snack foods will be stored in the kitchen separately from any cleaning products or other hazards. Medications will be stored in the locked cabinet inaccessible to the children; there is a refrigerator located in the kitchen for refrigerated medications. There are _2 toilets (30 capacity) and 2 sinks (30 capacity) accessible for children's use. Bathrooms are located near all classrooms. 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.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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

FACILITY NAME: BUILDING KIDZ ON 20TH AVENUE	FACILITY NUMBER: 384004791
	VISIT DATE: 11/08/2023

NARRATIVE

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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 a cozy area and staff bathroom will be used for an ill child.

Outdoor: The outdoor area measures 1,032 sq ft. allowing for a total of 13 children. Facility will use rotation schedule. 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 are rubber bark and sand. Children will bring individual water bottles. There will be pitcher and paper cups to allow children access to drinking water outside. Shade for children will be provided by building structures and tents if needed.

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 was conducted today. The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Facility building is a brand new development.

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, 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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, available at: http://www.ada.gov/childqanda.htm.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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

FACILITY NAME: BUILDING KIDZ ON 20TH AVENUE	FACILITY NUMBER: 384004791
	VISIT DATE: 11/08/2023

NARRATIVE

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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.

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.

Applicant was informed of the MyChildCarePlan.org site, 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.

A notice of site visit was given to applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant Sylvia Xuereb.

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 at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Licensure will be approved upon receiving fire clearance.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC809 (FAS) - (06/04)

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