384004915-6-25-2025-05-CC-CQUO-DHYUQG-20250625154707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004915
Report Date: 06/25/2025
Date Signed: 06/25/2025 03:47:24 PM

Document Has Been Signed on 06/25/2025 03:47 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:	L'ACADEMY PRESCHOOL MISSION NOE		FACILITY NUMBER:	384004915
ADMINISTRATOR/ DIRECTOR:	SELENE LI		FACILITY TYPE:	860
ADDRESS:	866 VALENCIA STREET		TELEPHONE:	(408) 916-7536
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 44	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/25/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Zhen Zhen Li & Selene Li		TIME VISIT/ INSPECTION COMPLETED:	04:00 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 June 25, 2025 at approximately 9:30am, Licensing Program Analysts (LPAs) Catrina Quimbo and Melissa Zargoza, conducted a scheduled, pre-licensing visit, to ensure that health safety and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. LPAs met with applicant, Zhen Zhen Li, and explained the purpose of the visit. Also present during LPA's visit included director of facility, Selene Li. Applicant is requesting to be licensed for a total capacity of 44 children: 16 infants (5 months to 18 months), 12 toddlers (18 months to 36 months) and 16 preschoolers (2 years to 6 years old). The fire clearance was approved on June 18, 2025 for 44 children. The center will operate Monday through Friday 8:30am to 5:30pm. LPAs toured and measured the on-limits areas and classrooms located at the facility. The facility has a total of 2 classrooms: Butterflies (preschool classroom) and Caterpillars (infant and toddler classroom). The toddler component is located in the Infant classroom, separated by bookshelves. Infant Classroom measurements are: The Indoor total measurements contain a total of 874 square feet which will not accommodate Applicant’s request for 16 infants and 12 toddlers. Infant Outdoor Play measurements are: Outdoor total measurements contain a total of 291.94 square feet, which will not accommodate Applicant’s request for 16 infants. Preschool Classroom measurements are: The Indoor total measurements contain a total of 499.59 square feet which will not accommodate Applicant’s request for 16 preschool children. Based on measurements taken today, the requested capacity will not accommodate the 44 children. (Continue Report on Page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025

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

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 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: L'ACADEMY PRESCHOOL MISSION NOE	FACILITY NUMBER: 384004915
	VISIT DATE: 06/25/2025

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
26
27
28
29
30
31
32

(Continued, Page 2...)
There is an outdoor area on site, located directly behind the Caterpillars classroom, that will be utilized for infants only. Applicant is working to finalize fencing in outdoor area to separate space from neighboring building. Applicant is also working to finalize setting up the outdoor area for infants. LPAs did not observe any pools, spas, or bodies of water on site.

There is no outdoor area for preschool children. Applicant plans to utilize local park, Mission Playground, which is a 3 minute walk (600 feet) from facility. Applicant has applied for a park permit through San Francisco Parks and Recreation. LPAs walked to Mission Playground during today's visit. Playground is fully fenced and enclosed. LPAs observed signage at playground that is labeled for children 2 years to 5 years old. There is a play structure with resilient padding.

The child care center was observed be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. Floors of all rooms have a surface that is safe and clean. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. Tables and chairs were observed to meet the needs of the children. All play equipment and materials used by children were observed to be age-appropriate.High chairs and feeding tables have broad-based legs, plastic seats are in good repair and trays lock onto chairs. High chairs are made of washable, moisture-resistant material.

LPAs observed all indoor activity space to be complete with safe, age appropriate furniture, including tables, chairs, napping cots, bookshelves and other activity supplies for the children. LPAs informed applicant and director that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, applicant stated they will be in a high cabinet in the Caterpillars classroom. Facility is equipped with multiple, new first aid kits. There is an operational carbon monoxide detector on site in each classroom. Licensing documents were observed to posted in each classroom. Children will be signed in and out of program with electronic signatures.

LPAs observed a total of 6 sinks available for children’s use. These are sufficient to accommodate the requested capacity of 44 children. LPAs observed a total of 2 toilets available for children's use. These are not sufficient to accommodate requested capacity of 44 children. Applicants plan to purchase potty training chairs for infants use. There is a separate staff restroom.

(Continue report on page 3...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025

LIC809 (FAS) - (06/04)

Page: 3 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: L'ACADEMY PRESCHOOL MISSION NOE	FACILITY NUMBER: 384004915
	VISIT DATE: 06/25/2025

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
26
27
28
29
30
31
32

(Continued, Page 3...)
Changing tables are located in the Caterpillars classroom, one changing table for each component. LPAs observed changing tables to have at least 1" padding covered with moisture resistant material. Sides of the changing table are at least 3" high and the changing table is within arm's reach of a sink. Diapering sink is not used for meal preparation or dishwashing.

Cots used for napping shall be maintained in a safe condition. Each cot shall be equipped with a sheet to cover the cot and, depending on the weather, a sheet and/or blanket to cover the child. Applicant plans for children to bring their own sheets and blankets that will be sent home weekly for laundering. Per director, cots are sanitized daily.

Cribs for infants are located in the Caterpillars classroom. The calculation of indoor activity space for infants shall not include space designated and used for cribs. The sleeping area for infants is physically separate from the indoor activity space via half wall. This barrier is at least four feet high, made of sound absorbing material and allows for supervision of napping children. Sleep logs will be kept. Needs and Services Plans and Sleep Plans are kept in children's files.

Drinking water is available with children's individual water bottles that are labeled with their individual names. There are drinking fountains on site, if needed. Per director, a filtered water pitcher is filled through Caterpillar's classroom sink, if needed.

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).

LPAs observed all hazardous items to be inaccessible to children. Isolation area will be in the classroom, separate from other children in care.

Facility will provide a food service that includes snack and lunch. Per director, food will be delivered weekly and prepared on site in the Caterpillars classroom. There is a refrigerator and sink that is free of rodents. LPAs observed cleaning materials to be stored in classrooms' high shelves.

The staff shall ensure that each child has an individual permanent or portable storage space for his/her clothing, personal belongings and/or bedding. All materials and surfaces accessible to children, including toys, shall be free of toxic substances.

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

(Continue Report on Page 4...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025

LIC809 (FAS) - (06/04)

Page: 4 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: L'ACADEMY PRESCHOOL MISSION NOE	FACILITY NUMBER: 384004915
	VISIT DATE: 06/25/2025

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
26
27
28
29
30
31
32

(Continued, Page 4...)
Director 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.

LPA reviewed with director, 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 director 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 director 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.

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-care-licensing/subscribe and select the Child Care option to receive email communication

Applicant was reminded children participating in the toddler option component, must have written authorization from the child's authorized representative prior to enrollment in toddler program.
(Continue Report o Page 5...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025

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: L'ACADEMY PRESCHOOL MISSION NOE	FACILITY NUMBER: 384004915
	VISIT DATE: 06/25/2025

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
26
27
28
29
30
31
32

(Continued, Page 5...)
The following corrections are needed prior to the issuance of a license:
-Working phone number for premises.
-Installation of toilet cover on children's toilet.
-Installation of sound alarms on exit doors in both classrooms.
-Inaccessibility of cat door on basement door.
-Securing cubbies in preschool classroom.
-Covering of mail slot on main entrance door.
-Covering of electrical outlets by children's sink.
-Finalization of fence in infant outdoor area.
-Covering of heater/air conditioner in infant outdoor area.
-Shade installation in infant outdoor area.
-Finalization of gap filling on floor in infant outdoor area.
-Installation of soft padding in infant outdoor area.
-Submission of outdoor rotation waiver.
-Submission of open space waiver.
-Submission of outdoor facility sketch (LIC999).
-Updated fire clearance with updated capacity.
-Centralized Application Bureau (CAB) final approval of application.
-Management approval.

Applicant, Zhen Zhen Li, understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

Exit interview conducted and report was reviewed with the applicant, Zhen Zhen Li.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025

LIC809 (FAS) - (06/04)

Page: 6 of 6