384004824-9-25-2024-05-CC-CQUO-D9FSF3-20240925134941

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004824
Report Date: 09/25/2024
Date Signed: 09/25/2024 01:49:49 PM

Document Has Been Signed on 09/25/2024 01:49 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:	TERRA SAN FRANCISCO PRESCHOOL		FACILITY NUMBER:	384004824
ADMINISTRATOR/ DIRECTOR:	XA, WENDY		FACILITY TYPE:	860
ADDRESS:	3801 BALBOA STREET		TELEPHONE:	(415) 906-2220
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94121
CAPACITY: 74	TOTAL ENROLLED CHILDREN: 13	CENSUS: 0	DATE:	09/25/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Wendy Xa		TIME VISIT/ INSPECTION COMPLETED:	02:15 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 September 25, 2024 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a scheduled, pre-licensing visit. LPA met with applicant, Wendy Xa, and explained the purpose of the visit. Application was received December 27, 2023. Facility has been under construction. As of this date, fire clearance has not yet been obtained. The applicant is requesting for a preschool program for a capacity of 74 preschool children (2 years to 5 years old). The facility will operate Monday through Friday 8:00am to 5:30pm. Applicant plans for children to be signed in and out of facility with authorized representatives' electronic signatures through an electronic application. The designated director for the facility will be Wendy Xa. The facility was inspected indoors and outdoors, for health and safety hazards, and measured to calculate capacity. The facility is a multi-level facility that also operates as a private elementary school (TK to 8th grade). The facility includes multiple classrooms, offices, and auditorium. The preschool program will operate in three classrooms: Preschool classroom #1, Preschool classroom #2, and Preschool classroom #3 (located in science wing building). The preschool program will also have access to the auditorium that is shared with elementary school. Entire third level of facility will be off limits to preschool children. Indoors: Preschool classroom #1 measured for 497.42 sq. ft. allowing for a capacity of 14 children. Preschool classroom #2 measured for 820.97 sq. ft. allowing for a capacity of 23 children. Preschool classroom #3 measured for 669.33 sq. ft. allowing for a capacity of 19 children. Total indoor square footage equals 1,987.72 sq. ft. allowing for a capacity of 56 children. LPA observed classrooms to be well ventilated with appropriate temperature. Applicant plans to utilize portable heaters, if needed. LPA reminded applicant portable heaters must be made inaccessible to children. Classrooms are equipped with furniture, toys and materials that are in good condition and age appropriate. There are carpets in classrooms that were observed to be clean and free of stains. LPA observed classrooms to include areas for dramatic play, motor development with manipulatives, art, writing, and quiet reading. There is sufficient storage space (cubbies) for children's personal belongings that will be located in the hallways. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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

FACILITY NAME: TERRA SAN FRANCISCO PRESCHOOL	FACILITY NUMBER: 384004824
	VISIT DATE: 09/25/2024

NARRATIVE

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LPA observed electrical outlets in classrooms to be made inaccessible, with child safety covers. Poisons, cleaning supplies and hazardous materials will be stored in classrooms' high shelves. LPA observed classrooms are equipped with fully charged fire extinguishers. Entire facility includes a fire alarm system. Applicant will install dual smoke and carbon monoxide detectors in each classroom. Proof of installation will be sent to LPA at a later date. LPA observed classrooms are also equipped with first aid kits. Applicant stated they are aware cleaning solutions and hazardous materials must be inaccessible to children in care.

Medications with children’s individual names and required documentation will be stored in appropriate classrooms, in an emergency backpack. Medications that require refrigeration will be stored in staff refrigerator in staff lounge.

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) tollfree 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.

Program plans to provide napping children with both cots and mats, depending on the needs of the child. Children's families are to provide blankets. Per applicant, blankets will be sent home weekly or as needed. Per applicant, cots and mats will be sanitized weekly or as needed.

Applicant plans for isolation area to be in "Nursery" office. "Nursery" office is equipped with a couch. Program's discipline policy was discussed. Applicant plans for staff to maintain communication with families and provide children with additional attention. LPA reminded applicant to conduct and document emergency disaster drills at least once every six months.

LPA observed each classroom to have multiple, accessible sinks for children's use. There is a shared restroom between Preschool classroom #1 and Preschool classroom #2 that includes 3 toilets. There are two additional, individual restrooms, located directly outside Preschool classroom #3 that include 2 additional toilets. Preschool program has access to 16 sinks and 5 toilets. Total allowable capacity for sinks is 240 children. Total allowable capacity for toilets is 75 children.

LPA observed sinks and toilets to be in proper working condition. Sinks children have access to do not provide water that is warmer than 120 degrees Fahrenheit. Applicant is aware children must be supervised going to and from restrooms.
(Continue Report on Page 3...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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: TERRA SAN FRANCISCO PRESCHOOL	FACILITY NUMBER: 384004824
	VISIT DATE: 09/25/2024

NARRATIVE

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Program plans to provide a food service that includes snack and lunch. Preschool children will eat in their designated classrooms. Food will be prepared in auditorium and brought to designated preschool classrooms. LPA reminded applicant cleaning solutions must be stored separate from where food is prepared.

Drinking water is available to children through their individual water bottles that can be refilled on site, through accessible sinks. The requirement for lead water testing was discussed.

The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Applicant was reminded a facility licensed after July 1, 2022, must have their water fixtures tested for lead 180 days after licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Outdoor: The outdoor area will be shared with private elementary school. Preschool program has access to entire outdoor area. LPA discussed waiver requirement to share outdoor area with elementary school. Outdoor area was measured for 15, 484.87 sq. ft. allowing for a capacity of 206 children. Outdoor area includes basketball hoops, tricycles and a variety of outdoor toys that are in good condition. LPA also observed artificial turf and tables with umbrellas in outdoor area. LPA did not observe any play structure or bodies of water on site. Entire outdoor area is fully fenced and enclosed. LPA reminded applicant children must always be supervised going to and from the outdoor area.

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.

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.

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.
(Continue Report on Page 4...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: TERRA SAN FRANCISCO PRESCHOOL	FACILITY NUMBER: 384004824
	VISIT DATE: 09/25/2024

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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-carelicensing/ subscribe and select the Child Care option to receive email communication.

Based on indoor square footage, maximum number preschool program can be licensed for is 56 preschool children.

Prior to licensure, following is to be completed:
-Proof of installation for carbon monoxide detectors in each preschool classroom.
-Submission of updated facility sketch (LIC999) for Preschool classroom #3.
-Proof of licensing documents posted in facility.
-Fire clearance.
-Submission of new director packet for facility 214005471.
-Submission and approval of updated admission agreement with rights of licensing agency.
-Applicant's MMR immunity.
-Management approval.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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