Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002539
Report Date: 05/03/2018
Date Signed: 05/03/2018 02:10:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ALEMANY CENTER-HEAD START (PS)FACILITY NUMBER:
384002539
ADMINISTRATOR:PETERSON, VALERIEFACILITY TYPE:
850
ADDRESS:956 ELLSWORTH STREETTELEPHONE:
(415) 635-0904
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:18CENSUS: 18DATE:
05/03/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Valerie PetersonTIME COMPLETED:
02:15 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
Licensing Program Analyst (LPA) Manlutac performed an unannounced random annual inspection at the facility at issue. LPA met with Valerie Peterson, purpose of the inspection was explained. Present during the inspection were the site supervisor, three teaching staff and 18 preschool aged children, the facility is operating within ratio and within licensed capacity on this day. LPA inspected inside and outside of the facility for health and safety hazards. LPA also reviewed children and personnel files for required licensing documents.

Per director there are no firearms or weapons on the premises. LPA did not observe any bodies of water on the premises. The facility is equipped with a smoke alarm, a carbon monoxide detector, and a fully charged fire extinguisher that meets minimum size requirements. Cleaning supplies are stored in the adult bathroom which is inaccessible to the children. Medications are stored in backpacks which were out of reach from the children. The classroom was clean and orderly with a sufficient amount of learning materials and age appropriate furniture in well repair available to the children. The bathroom and kitchen surfaces appeared clean and sanitary. Trash receptacles had tight fitting lids in well repair. Uncontaminated drinking water is available to the children via pitcher. Menus are posted for the month on a posting board. The playground was free from hazardous materials and had sufficient padding around the play structure.

Staff records had appropriate education units and current first aid CPR certification. All staff had complete immunization records. Children files had admission agreements available for review, documented immunization records, and signed slips for parents rights notification and personal rights.

(report continued on next page)
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Lorenzo ManlutacTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2018
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ALEMANY CENTER-HEAD START (PS)
FACILITY NUMBER: 384002539
VISIT DATE: 05/03/2018
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
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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

No deficiencies were cited on this day. A copy of this report was reviewed and left with Valerie along with a notice of site visit which is to be posted for 30 days.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Lorenzo ManlutacTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2018
LIC809 (FAS) - (06/04)
Page: 2 of 2