380504354-12-19-2023-05-CC-LGOZ-CYNRZY-20231219122840

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380504354
Report Date: 12/19/2023
Date Signed: 12/19/2023 12:28:49 PM

Document Has Been Signed on 12/19/2023 12:28 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-ZAIDA T. RODRIGUEZ (EES) PRESCHOOL		FACILITY NUMBER:	380504354
ADMINISTRATOR:	MANCINA, JANE		FACILITY TYPE:	850
ADDRESS:	2950 MISSION STREET		TELEPHONE:	(415) 695-5842
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94110
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 60	CENSUS: 24	DATE:	12/19/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Oscar Chavez		TIME 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 12/19/2023 at 9:40AM., Licensing Program Analysts (LPAs), Luis Gomez and Janet Gil met with Lead Teacher, Oscar Chavez. Purpose of inspection was explained and was for an Annual Random inspection. Per lead teacher, school principal Lidsey Keener is current unavailable. Facility is licensed to operate a preschool program. Present were six staff supervising 24 children. Children present had been properly signed into the program. The criminal record clearances for classroom personnel are completed to through school district. The program utilizes two classrooms: #3, #4 and one, shared, outdoor play area. The days and hours of operation are Monday- Friday, 7:30AM- 5:30PM. LPAs inspected facility for health and safety hazards. At 9:55AM., the following was observed: Classrooms were maintained clean and orderly, with age-appropriate materials available. Floor and ground surfaces leading to exits, were clear of any obstructions or hazards. For storage of belongings, cubbies are located in each classroom. Accessible furniture, playthings and supplies inspected were in good repair. LPAs observed child- sized tables available. The children’s bathrooms were observed clean, with fixtures in operating condition. The staff/ adult bathrooms are located separately. Classrooms was a comfortable temperature, with adequate ventilation and lighting. Electrical outlets and trash bins had proper coverings. Facility had several (built-in) smoke detectors, testable carbon monoxide detector, telephone service, and a fire extinguishers: 2A:10:BC. Detergents, cleaning compounds, and toxins had been made inaccessible. Facility’s first aid kit was fully stocked. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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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Document Has Been Signed on 12/19/2023 12:28 PM - It Cannot Be Edited

Created By: Luis Gomez On 12/19/2023 at 11:32 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: SFUSD-ZAIDA T. RODRIGUEZ (EES) PRESCHOOL	FACILITY NUMBER: 380504354
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 11:05AM., Based on record review and interviews, LPAs confirmed staff's cardiopulmonary resuscitation / first aid certifications had expired. This poses a potential health and safety risk to children in care.
	POC Due Date: 01/08/2024
	Plan of Correction
1 2 3 4	Facility will ensure staff have completed the required CPR/first aid certification by the due date: 1/8/2024. Certification will be stored in the personnel file. Proof of correction will be submitted to the department via email.

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:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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-ZAIDA T. RODRIGUEZ (EES) PRESCHOOL	FACILITY NUMBER: 380504354
	VISIT DATE: 12/19/2023

NARRATIVE

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At 10:20AM., LPAs inspected the outdoor play area. Area was completely enclosed with shaded resting areas available for the children. Playthings reviewed were in like-new condition. Per Lead Teacher, broken tricycles are regularly replaced. LPAs observed an available (anchored) climbing structure, with absorbent material installed for added safety. Water services are provided, inside and outside with water fountains.

LPAs reviewed the food preparation/storage area. The food items had been properly stored, and area was free of trash or rubbish.

At 11:00AM., LPAs reviewed facility records including two children’s files and five personnel files. Staff’s files were reviewed contained the: Notice of Employee Rights (LIC9052); Teacher Qualifications; Mandated Reporter Training Certifications (AB1207); and Personnel Record (LIC501).

At 11:05AM., Based on record review and interviews, LPAs confirmed staff's cardiopulmonary resuscitation / first aid certifications had expired.

At 11:10AM., Based on record review, LPAs confirmed staff's proof of required immunization missing from the facility records. Advisory Note: Technical Violation (LIC9102TV) was issued to facility.

Children’s files were reviewed and contained the: Consent for Emergency Medical Treatment; Immunization Records, Identification and Emergency Information; Notification of Parent’s Rights (LIC995); and ‘Written Medical Assessments’.

Disaster drills are conducted on site, with the last drill completed on 10/14/2023, properly logged.

Required posted had been posted in lobby including the: Facility License; Notification of Parent’s Rights (PUB394); Food Service Menu (December); Earthquake Preparedness Checklist; and Child Passenger Safety Laws (PUB269). LPA reminded facility to post the LIC610, Emergency Disaster Plan. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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-ZAIDA T. RODRIGUEZ (EES) PRESCHOOL	FACILITY NUMBER: 380504354
	VISIT DATE: 12/19/2023

NARRATIVE

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For IMS information see PIN 22-02CCP. 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, statues 2018 requires all licensed childcare centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

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

Based on today's inspection, deficiencies were cited in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations and cited on 809D. Exit interview, plan of correction and report was reviewed with Lead Teacher, Oscar Chavez. Signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit must remain posted for 30 days. Lead Teacher was advised if she had additional questions to contact the Community Care Licensing office, Mon-Fri, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

LPAs were unable to print report during inspection. Copy of report will be send to facility at a later date.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC809 (FAS) - (06/04)

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