384004089-11-28-2023-05-CC-JYEE-CXZR9X-20231128115017

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004089
Report Date: 11/28/2023
Date Signed: 11/28/2023 11:50:26 AM

Document Has Been Signed on 11/28/2023 11:50 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	EXCELSIOR FAMILY CONNECTIONS		FACILITY NUMBER:	384004089
ADMINISTRATOR:	SIHAPANYA, YENSING		FACILITY TYPE:	850
ADDRESS:	5016 MISSION STREET		TELEPHONE:	(415) 333-3845
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94112
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 20	CENSUS: 13	DATE:	11/28/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Gia Turner		TIME COMPLETED:	12:00 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 Analysts (LPA) Yee conducted an annual inspection today. The purpose of the inspection was explained. Present at the facility are site director, two staff members, and 13 preschool children. Teacher-to-child ratios is in compliance during today's visit. Days and hours of operation: Monday - Friday, 9:00 am - 5:00 pm. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The outside yard is adjacent to the classroom. Waiver for yard rotation schedule is posted. LPA and facility representative, Ms. Ortega toured and inspected the Center for Health and Safety Hazards. Daycare areas: One classroom. Outdoor yard is inspected. LPA observed outdoor equipment is in good condition, free from loose, sharp, or pointed parts. There are no swimming pools, spas, or other bodies of water on the premises. All cleaning supplies and other potentially harmful items are made inaccessible to the children. Furniture and equipment are in good condition. The facility provides snacks. Children bring their own lunches. Menu is posted. Drinking water is provided indoors (water pitcher, water fountain) and outdoors (water fountain). The last Emergency Drill was conducted on 06-13-2023 and properly logged. During the visit, LPA reviewed 3 staff members' records. At least one staff have current Pediatric First Aid and CPR until 06-09-2025. Children files were reviewed and in order. Sign-in and sign-out sheets were reviewed. An isolation room for a sick child is located near the front office and will use staff bathroom as needed. Designate a teacher to stay with the child, then call parents for pick up. LPA discussed the Mandated Reporter Training, AB1207 that was effective on 1/1/2018. All staff must take the training and keep the certificate on file. The training needs to be renewed once every 2 years. Some staff members need to renew their Child Abuse Mandated Reporter Training, AB1207 and submit current certificate to CCL by December-30-2023. https://www.mandatedreporterca.com/ continue next page.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: EXCELSIOR FAMILY CONNECTIONS	FACILITY NUMBER: 384004089
	VISIT DATE: 11/28/2023

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Center (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.

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

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 PIN 22-02-CCP. 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/resources/child-care-centers/.

The facility representative, Ms. Turner was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPAs obtained LIC9275, LIC9276 LIC999, LIC500 during the visit.

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

Exit interview conducted and report was reviewed with the facility representative, Ms. Turner.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

LIC809 (FAS) - (06/04)

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