414002881-4-3-2025-05-CC-JGIL-DFDQME-20250403121724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002881
Report Date: 04/03/2025
Date Signed: 04/03/2025 12:17:36 PM

Document Has Been Signed on 04/03/2025 12:17 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:	PFS-BAYSHORE MISSION STREET CDC (INFANT)		FACILITY NUMBER:	414002881
ADMINISTRATOR/ DIRECTOR:	WHEATLEY, KELLEY		FACILITY TYPE:	830
ADDRESS:	7222 MISSION STREET		TELEPHONE:	(650) 758-0743
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 23	CENSUS: 18	DATE:	04/03/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Liezel Caparas		TIME VISIT/ INSPECTION COMPLETED:	12:35 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 April 3rd, 2025 at approximately 9:00 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. At the time of inspection, site director, Kelley Wheatley, was away from facility on maternity leave. LPA met with lead teacher, Liexl Caparas. Lead teacher is designated with facility responsibility. Per staff, director is expected to return within the next two weeks. Hours of operation are Monday to Friday 7:00 AM to 5:45 PM. Present during inspection for the infant license, included 18 children with 8 staff members(including Internal Site Manager, and F.A.C.E. Coordinator). Facility is operating within capacity requirements and ratios at time of LPA's inspection. Facility has two licenses. Facility is a combination program of an infant and preschool license. Program operates in 4 classrooms: "Preschool", "Toddler ", "Wobblies", and "Infant". Under the infant license, the program operates in "Toddler", "Wobblies" and "Infant" classrooms. LPA inspected facility, indoors and outdoors, for health and safety hazards. LPA observed infant classrooms to be clean, equipped with age appropriate toys, materials, and furniture. LPA observed electrical outlets to be made inaccessible with outlet covers and furniture. LPA also observed covered trash cans in the classrooms. Children' blankets and sheets are provided by program and are washed daily for infant program. Infant classrooms and Toddler Room children have designated napping areas. LPA observed napping area to include cribs and cots for toddlers. Sleeping logs are maintained for napping infants. LPA observed facility has an installation of a fire alarm system throughout the entire building. Smoke/carbon detectors were not tested due to being on high ceilings. Infant/Toddler classrooms have multiple fully stocked and accessible first aid kits. Facility has multiple fire extinguishers throughout the building. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children on facility's high shelves or locked under sinks enclosed kitchen area. Continue on Page 2...

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Janet Gil
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

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: PFS-BAYSHORE MISSION STREET CDC (INFANT)	FACILITY NUMBER: 414002881
	VISIT DATE: 04/03/2025

NARRATIVE

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LPA observed there is a diaper changing station in the "Wabbilies" classroom bathroom that is within arm's reach to an adult sink. There is a kitchen between "Preschool" and "Toddler" room. Also, there is a shared kitchen area between "Wobblies" and "Infant" classes.

Facility provides a food service that includes a morning snack, lunch, and afternoon snack. Food is prepared in shared kitchen areas. LPA observed kitchen area to be clean. Per teacher in infant room, class and kitchen areas are sanitized daily. Parents and authorized representatives provide all formula for enrolled children that is packaged and stored inside the classroom/refrigerator. All formula/milk for infants is properly stored in labeled containers with each infants name and in the refrigerator. Water is available to children indoors and outdoors with children's water bottles.

There is a separate outdoor area for infants. "Wobblies" and "infant" classes share another separate outdoor area from toddler area. Outdoor area is fully enclosed and was observed to have age appropriate toys and materials that were observed to be in working condition. LPA did not observe any pools, spas, or bodies of water in day care areas.

Children are signed in and out of facility through Kinder Connect by the front entrance. All children were signed in correctly during LPA's visit. Facility has license documentation and information properly posted and available for review. Facility conducts drills at least once every six months. Last conducted disaster drill was on 11/27/2024.

LPA reviewed 6 children's files and 5 staff files. Children's and staff files were complete with a record of emergency identification information on file. All present staff have a valid CPR/First Aid certificate and proof of required immunization that were made available for review. Mandated Reporter Training Certificates are also on file for each staff.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completed certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Janet Gil
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

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: PFS-BAYSHORE MISSION STREET CDC (INFANT)	FACILITY NUMBER: 414002881
	VISIT DATE: 04/03/2025

NARRATIVE

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Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes 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-years 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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with lead teacher, Liexl Caparas.

NAME OF LICENSING PROGRAM MANAGER: Garfield Leung
NAME OF LICENSING PROGRAM ANALYST: Janet Gil
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

LIC809 (FAS) - (06/04)

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