384004434-9-22-2021-05-CC-HRCO-C74MXN-20210922100012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004434
Report Date: 09/16/2021
Date Signed: 09/22/2021 10:00:22 AM

Document Has Been Signed on 09/22/2021 10:00 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	NOE VALLEY KIDS		FACILITY NUMBER:	384004434
ADMINISTRATOR:	TOLEDO, JORDAN		FACILITY TYPE:	830
ADDRESS:	3800 22ND STREET		TELEPHONE:	(415) 619-2293
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94114
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/16/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Miranda Pan		TIME COMPLETED:	03:20 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) Haydee Caliboso met with applicant Miranda Pan (Owner) on 9/16/21 for a pre-licensing inspection. The applicant has requested a combination of an infant with toddler component program. The applicant has requested for 24 infants, ages birth to 24 months, and 12 toddlers, ages 18 months to 36 months. The facility building that will be used for the program is on the lower level of a commercial building. The program plans to operate Monday - Friday; 7:300 AM to 6:00 PM. The facility was inspected today, indoor and outdoor, for health and safety hazards, and was measured to calculate capacity. This inspection included a technical assistance inspection for COVID-19 guidance and support. Indoor: There is one classroom that will be used for the two component programs. There is a physical partition in the classroom for the infant program and for the toddler program. The infant classroom was calculated for 624.06 sq. ft, allowing for a capacity of 18 infant children. Toddler classroom was calculated to be 510.11 sq. ft, allowing for a capacity of 14 toddler children. The facility was observed today to be clean and equipped with a fire extinguisher, and both smoke and carbon monoxide detectors. The facility is adequately ventilated and free of insects and bugs. The classroom and furniture equipment are clean and in good condition. Children’s toys and supplies are orderly, in good condition, and age appropriate. There is storage space for children's personal belongings. The facility has no designated kitchen for staff to use. There are sinks available for staff and children to use. The facility has a first aid kit and a designated backpack with emergency supplies. Cont. 809-C pg. 2

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NOE VALLEY KIDS	FACILITY NUMBER: 384004434
	VISIT DATE: 09/16/2021

NARRATIVE

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Refrigerated medications will be stored separately from food. Medication will be administered with parental consent and will be kept in the child’s file for record. All medication will be logged when administered to children. The family will provide morning and afternoon snacks, and lunch daily. The family will provide a sheet and blanket for the children. Bedding is to be washed twice per week or as needed. Mats will be used for older infants and will be cleaned daily or as needed. The toddler classroom has 3 toilets and 4 sinks available for children to use. The bathroom is observed to be clean and with no health or safety hazards.

Infant: There is storage for infants’ personal belongings. The family will provide diapers and wipes for the infant. The family will also provide bottles/nipples and any other food service items for each infant, and the staff will ensure breastmilk and or milk formula is served fresh daily to the infant. There are 6 cribs available for infant to use. The owner has stated, additional cribs will be purchased as enrollment increases. Medications for infants will be stored in the classroom in high cabinets or in locked boxes in the refrigerator. All furnishings and equipment are observed to be safe, in good condition, and age appropriate. Staff will meet and review the individual written needs and service plans quarterly with the parents. Plans will be kept in the children’s files. Bottles and food shall be labeled. Food and milk that is not consumed is sent home daily. Staff will meet and review individual written plans quarterly with the parents.

There is a separate bathroom available for staff to use. The isolation area for ill children is located at the back of the toddler classroom. Staff bathroom will be used for ill children, if needed, until parents arrive for pick-up. Children in the program will be signed in and out daily by parents. The facility will conduct and log fire drills once every six months, and the log will be available upon request. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children.

Cont. 809-C pg. 3

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NOE VALLEY KIDS	FACILITY NUMBER: 384004434
	VISIT DATE: 09/16/2021

NARRATIVE

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Outdoor: The facility has no outdoor play area. The program has submitted an open space playground waiver to San Francisco Park and Recreation Department to use the children’s playground at Noe Children’s Playground located at 798 Douglass St. San Francisco which is 0.6 miles away from the facility. The facility’s outdoor playground is enclosed and gated with a fence approximately 4 ft. tall. The approval of permit from San Francisco Recreation Park for playground usage is currently pending. The park was inspected and meets the requirements for the open space waiver. Children will walk to the park. Teachers will bring children’s water bottles for playground use. LPA reminded Miranda Pan to ensure ratio and supervision are observed at all times

The following items were reviewed as part of today’s visit: Record keeping for staff, children, and facility records, care and supervision of the children, child discipline procedures – staff will use positive discipline and redirection. Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Safe Sleep and Individual Infant Sleeping Plan (LIC 9227), Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements were reviewed today.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. 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

An electronic copy of this three-page report was emailed to Miranda Pan. Applicant was asked to review the report and return a signed copy of the report to LPA Haydee Caliboso. COVID-19 Self-assessment guide was received and reviewed today with Miranda Pan.

Based on available square footage, LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 32 children. The following corrections need to be made and submitted for further review before a recommendation for licensure with a capacity of 32 can be made:

· Obtain park usage permit from SF Parks and Recreation.
· Napping mats are available for each toddler with no exposed foam.
· Diaper changing table area with a sink within arms of reach.
· First Aid Kit supplies are accessible for staff but made inaccessible for children.
· Replenish First Aid Kit that contains supplies that are available for children and staff usage.
· Garbage cans with tight fitting lids.
· Proof of portable bottle warmers for the infant program are available and placed in a safe area.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC809 (FAS) - (06/04)

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