384005186-6-18-2026-05-CC-CQUO-DV6RW8-20260618132243

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384005186
Report Date: 06/18/2026
Date Signed: 06/18/2026 01:23:08 PM

Document Has Been Signed on 06/18/2026 01:23 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:	SFUSD-MISSION BAY SCHOOL		FACILITY NUMBER:	384005186
ADMINISTRATOR/ DIRECTOR:	KRISTY OUYANG		FACILITY TYPE:	860
ADDRESS:	1415 OWENS STREET		TELEPHONE:	(415) 615-8100
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94158
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/18/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Kristy Ouyang		TIME VISIT/ INSPECTION COMPLETED:	01:45 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 18, 2026 at approximately 9:15am, Licensing Program Analysts (LPAs) Quimbo and Tso conducted a scheduled, pre-licensing visit. LPAs met with facility representative, Kristy Ouyang, and explained the purpose of the visit. This is an initial application. Application was submitted February 27, 2026 and is requesting for 48 preschool children (2 years to 6 years old). Fire clearance for 48 children was received April 6, 2026. Multi-level facility is an elementary school for children in grades TK through 5th grade. The preschool component will operate on the ground level of the facility in classrooms #128 and #145 only. The preschool component will operate Monday through Friday 7:30am to 5:45pm. All staff that will be working with the preschool component will be fingerprinted through the San Francisco Unified School District. The site supervisor will be the elementary school's principal, Monette Benitez. LPAs inspected day care areas for health and safety hazards and measured day care areas to ensure square footage is sufficient per the capacity requested. Preschool Indoor measurements are: There are 2 classrooms for the preschool component. The indoor area contains a total of 1,930.09 square feet which will accommodate the request for 48 preschool 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: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

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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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)

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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: SFUSD-MISSION BAY SCHOOL	FACILITY NUMBER: 384005186
	VISIT DATE: 06/18/2026

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Preschool Outdoor measurements are:
There is 1 outdoor area for the preschool component. The outdoor area contains a total of 4,362.37 square feet which will accommodate the request for 48 preschool children.

Preschool sinks and toilets:
There are 8 sinks and 4 toilets available for preschools' use. Toilet and sink ratio is sufficient to accommodate the request for 48 preschool children.

The child care center was observed to be clean, sanitary and in good repair. A comfortable temperature in the facility is being maintained. Furniture and equipment for children's use were observed to be in good condition. Tables and chairs for children's use are age appropriate. There are rugs in the classrooms that were observed to be clean, free of stains. Per facility representative, rugs will be vacuumed daily through school's janitorial services.

Storage for children's belongings are located inside the preschools' classrooms. LPAs observed there is sufficient storage space for the number of children being requested. LPAs observed cabinets in classrooms do not have any poisons or cleaning solutions stored. There are water fountains in the classrooms that were observed to be in working condition.

There are two restrooms for preschool children's use, one located in each classroom. LPAs observed restrooms to be in working condition. Children who may need diapering assistance will be providing their own diapers and wipes that will be stored at the facility, labeled with their individual names. Diapering children will be changed in a standing position. Dirty diapers will be disposed of in individual plastic bags and in garbage bins with tight fitting lids. There are sinks in the classroom that provide hot water. LPAs advised facility representative for hot water to be lowered.

Preschool children will sleep in their classrooms on floor mats. LPAs observed floor mats to be color coded, to differentiate between which side is floor touching and which side will be for the child to lay on. Sheets and blankets will be provided by children's families and will be sent home weekly for laundering. Sheets and blankets will be stored in children's cubbies so that they are not touching each other. LPAs observed floor mats to be stored appropriately when not in use. LPAs also observed floor mats to have an area to be labeled with children's individual names.
(Continue report on page 3...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

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: SFUSD-MISSION BAY SCHOOL	FACILITY NUMBER: 384005186
	VISIT DATE: 06/18/2026

NARRATIVE

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Both classrooms are equipped with first aid kits. Facility includes a fire alarm system, fire sprinklers, and multiple fully charged fire extinguishers. LPAs observed both classrooms are also equipped with carbon monoxide detectors that were tested during today's visit and observed to be in working condition. When medications are on site, they will be stored in a high shelf or emergency backpack, that will be located in designated classrooms, inaccessible to children.

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

Licensing documents will be posted in the hallway between both classrooms. Children will be signed in and out of program with written signatures. Per facility representative, sign in and out sheets are maintained for 5 years.

Preschool outdoor area is physically separate from the TK and elementary school's outdoor areas. Preschool outdoor area is fully fenced and enclosed. There is shade, if needed. LPAs observed a play structure in the preschool outdoor area that is labeled for children ages 2 years to 5 years old. Play structure sustains the weight of an adult and has rubber padding underneath. There are accessible water fountains in the outdoor area, if needed. LPAs did not observe any pools, spas or other bodies of water on site.

Program will provide a food service for children that includes breakfast, lunch and snack. Food is prepared through a third party vendor and will be delivered to the facility daily. Food will be prepared in on site kitchen. Disposable utensils and plates will be utilized for children. Reusable dishes and materials may be utilized for children in the future and will be sanitized daily through on site dishwasher.
(Continue report on page 4...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

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: SFUSD-MISSION BAY SCHOOL	FACILITY NUMBER: 384005186
	VISIT DATE: 06/18/2026

NARRATIVE

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Drinking water is available through multiple accessible water fountains. 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). Facility was built after 2010. Proof of when facility was built will be submitted to the department.

LPA reviewed with facility representative the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Facility representative 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

If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Facility representative 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.
(Continue report on page 5...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

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: SFUSD-MISSION BAY SCHOOL	FACILITY NUMBER: 384005186
	VISIT DATE: 06/18/2026

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Facility will be approved for a total capacity of 48 preschool children when following is complete:
-Required licensing documents posted.
-Covering of electrical outlets in both classrooms.
-Lowering hot water on the right side, classroom sink in classroom #145.
-Lowering hot water on the left side, classroom sink in classroom #128.
-Garbage bins with tight fitting lids in both classrooms.
-Sound alarm on exit doors in both classrooms.
-Proof that supervision will be maintained in the children's restrooms for both classrooms, effectively.
-Padding on poles in classroom #128.
-Smoothing edges on planter boxes in preschool's outdoor area.
-Padding on concrete seats' corners in preschool's outdoor area.
-Sound alarm on exit gate that leads to street in preschool's outdoor area.
-Centralized Application Bureau (CAB) final approval of application.

Exit interview conducted and report was reviewed with the facility representative, Kristy Ouyang.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC809 (FAS) - (06/04)

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