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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004891
Report Date: 11/12/2024
Date Signed: 11/12/2024 01:29:02 PM

Document Has Been Signed on 11/12/2024 01:29 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:RUSSIAN HILL ACADEMYFACILITY NUMBER:
384004891
ADMINISTRATOR/
DIRECTOR:		JIALI ZENGFACILITY TYPE:
860
ADDRESS:1520 PACIFIC AVENUETELEPHONE:
(415) 260-0393
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: DATE:
11/12/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Applicant's spouse Randy ChoiTIME VISIT/
INSPECTION COMPLETED:
01:27 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Jamel Maiwandi and Community Care Licensing Division (CCLD) Analyst Zeynep Basak met with applicant’s spouse Randy Choi for the purpose of an announced pre-licensing inspection at 1520 Pacific Avenue San Francisco CA, 94109 on 11/12/2024 at approximately 10:00am. Also present was consultant Tony Ng. Applicant Jiali Zeng was not present during this inspection. Applicant requests a preschool component to serve 43 preschool children from age two years to six years old and a toddler component to serve 12 toddler children from ages 18-36 months. The program will operate Monday through Friday from 8:00 a.m. to 5:30 p.m. Fire clearance was granted on 10/31/24.

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.

INDOOR ACTIVITY SPACE:
There is one toddler classroom (#1) and two preschool classrooms (#1, #2) located in the facility, and a staff restroom located next to preschool classroom #1. The isolation area for sick children will be located next to the main entrance after entering the preschool classroom. The food preparation area is located next to the toddler classroom and is inaccessible to children. Staff was reminded that all kitchen, food preparation and storage areas shall be kept clean and free of litter and rubbish, and measures shall be taken to keep all such areas free of rodents and other vermin. LPA measured the classrooms which includes a total of 1,574.62 square feet and will not accommodate the applicants request for 43 preschool children. LPA observed a sufficient amount of equipment, toys, tables, chairs, napping mats, and cubbies in each room. Randy Choi stated there will be a first aid kit located in each classroom and appropriately stored and inaccessible to children.

Report continues on LIC 809 page 2
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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 3
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: RUSSIAN HILL ACADEMY
FACILITY NUMBER: 384004891
VISIT DATE: 11/12/2024
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Medications will be stored and inaccessible to children in the food preparation area in locked storage cabinets and accordingly to each individual child. Cleaning and disinfectant agents will be stored in locked cabinets and will be inaccessible to children in the food preparation area as well. Drinking water will be provided for children via drinking fountains and parents will provide drinking water as well. LPA observed a functional carbon monoxide detector in both levels. Randy Choi stated a digital sign in and sign out process will be used and a paper sign in and sign out process will be used as a backup. Parents will be solely responsible for providing sheets, blankets, and pillows for their children. There is a total of six toilets and five sinks available for children. In addition to the children’s sinks, there is one sink for staff in the food preparation area. There is a dedicated mobile line for the facility located with the director Jiali Zeng and teachers. Staff was informed facility shall be kept clean, safe, sanitary and in good conditions at all times to ensure the safety and well-being of children, employees and visitors. There are no poisons or firearms located in the facility.

OUTDOOR ACTIVITY SPACE:
There is not an outdoor activity area located in the facility. In lieu of an outdoor activity space, the applicant has submitted a waiver request with a safety plan to utilize Helen Wills public park to fulfill outdoor play space. The park is located directly behind the facility. LPA advised staff to ensure proper transportation of children and supervision ratios while children are outside.

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. LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with staff any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on LIC 809 page 3
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: RUSSIAN HILL ACADEMY
FACILITY NUMBER: 384004891
VISIT DATE: 11/12/2024
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Staff were 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. Staff were 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.

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. Assembly Bill (AB) 2370, /chapter 676, Statues 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-year after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP)

Exit interview conducted and report was reviewed with Applicant’s Spouse Randy Choi.

The following is required before a license will be issued:
1. Revised LIC 200A with updated capacity
2. Revised fire clearance with updated capacity
3. Proof of first aid kits
4. Final LPM approval
5. Updated Facility Sketch with isolation area
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3