414004137-11-18-2024-05-CC-CQUO-DB5QQZ-20241118112310

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004137
Report Date: 11/18/2024
Date Signed: 11/18/2024 11:23:15 AM

Document Has Been Signed on 11/18/2024 11:23 AM - 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:	JOHN F. KENNEDY ELEMENTARY		FACILITY NUMBER:	414004137
ADMINISTRATOR/ DIRECTOR:	PACE, KENNETH		FACILITY TYPE:	850
ADDRESS:	785 PRICE STREET		TELEPHONE:	(650) 991-1239
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 18	CENSUS: 9	DATE:	11/18/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:20 AM
MET WITH:	Chielo Yusta		TIME VISIT/ INSPECTION COMPLETED:	11:35 AM

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 November 18, 2024 at approximately 8:20am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with lead teacher, Chielo Yusta, and explained the purpose of the visit. Present during LPA's visit included lead teacher, 2 teacher's assistants and 9 preschool children. All teaching staff are fingerprinted through Jefferson Elementary School district. Hours of operation are Monday through Friday 8:00am to 2:30pm. Preschool program operates at John F. Kennedy Elementary School in classroom #32 only. With lead teacher, LPA inspected preschool classroom and outdoor area for health and safety hazards. LPA observed preschool classroom to be appropriately ventilated. There is a humidifier in classroom for appropriate air flow. Classroom is clean and equipped with a variety of toys and equipment that are in good condition and age appropriate. LPA observed flooring to be clean. There are rugs in the classroom that are free of stains. Children's toys, materials and furniture are age appropriate and in good working condition. LPA observed cleaning solutions and chemicals to be stored in classroom's high shelves, inaccessible to children. LPA observed electrical outlets to be covered and made inaccessible. Storage for children's belongings are located inside the classroom, inside a cabinet. LPA observed children's belongings to be stored in bins in the cabinet, labeled with each child's individual names. Children sleep in the classroom on cots. LPA observed children's sheets and blankets to be stored appropriately, so they are not touching each other. School district provides sheets. Per lead teacher, sheets and blankets are sent home weekly to be laundered. Per lead teacher, cots are also sanitized weekly. Classroom is equipped with a fully charged fire extinguisher, smoke alarm and smoke detector. There is also a carbon monoxide detector in the classroom that was tested during visit. LPA observed carbon monoxide detector to be working during today's visit. Classroom is equipped with a working telephone. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

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 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: JOHN F. KENNEDY ELEMENTARY	FACILITY NUMBER: 414004137
	VISIT DATE: 11/18/2024

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...)
Children's restroom is located inside the classroom. LPA observed restroom to be in working condition. Children's restroom is equipped with age appropriate toileting equipment and sanitation materials. LPA advised lead teacher to maintain garbage bins in classroom with tight fitting lids.

There are accessible sinks in the classroom that are in working condition. Children have access to drinking water through filtered water pitchers that can be refilled through the classroom sinks.

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.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Food service is currently provided by school district. Food service includes breakfast and lunch only. LPA observed menu to be posted in classroom, available for review.

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/.

Outdoor area is fully enclosed and fenced. Outdoor area is shared with other school district programs at elementary school. LPA observed outdoor rotation waiver posted in preschool classroom, available for review. Outdoor area includes a variety of outdoor toys and materials that are in good condition. There is a play structure in the outdoor area with resilient padding underneath. There are storage sheds that were observed to be locked and made inaccessible to children. LPA observed garbage bins in outdoor area with tight fitting lids. LPA did not observe any pools, spas or bodies of water on site.
(Continue Report on Page 3...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC809 (FAS) - (06/04)

Page: 2 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: JOHN F. KENNEDY ELEMENTARY	FACILITY NUMBER: 414004137
	VISIT DATE: 11/18/2024

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...)
Preschool children are signed into and out of program with their authorized representatives' written signatures. LPA observed children present to be signed in appropriately. LPA observed sign in sheets to include the child's name and the time they are signed into and out of program.

Licensing documents are properly posted and available for review. Emergency disaster drills are conducted monthly with the entire school district.

LPA reviewed 6 random children's records which are complete. Children's records include emergency contact information and immunization cards. Lead teacher's CPR/First Aid certification is current and will expire 12/2025. LPA was unable to review staff records as they are maintained in school district's main office. LPA advised lead teacher to maintain staff records at facility.

To improve the quality and value of the new inspection process, a survey may 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 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, 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.

Facility representative was informed of the MyChildCarePlan.org website; 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.

Facility is being cited a Type B citation for not completing lead water testing requirement prior to due date. Lead water testing results are within the 5.5ppb range, deficiency issued during today's visit will also be cleared during today's visit. Appeal Rights and plan of correction letter were provided during visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Chileo Yusta

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 11/18/2024 11:23 AM - It Cannot Be Edited

Created By: Catrina Quimbo On 11/18/2024 at 10:25 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JOHN F. KENNEDY ELEMENTARY	FACILITY NUMBER: 414004137
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/18/2024
	Plan of Correction
1 2 3 4	Due date to complete lead testing was January 1, 2023. Faciilty's lead testing was completed March 9, 2024, passed the due date. Lead testing results are within 5.5ppb threshold. Deficiency cleared during visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Catrina Quimbo

LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4