410518055-2-29-2024-05-CC-CQUO-D2WRHR-20240229120247

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518055
Report Date: 02/29/2024
Date Signed: 02/29/2024 12:03:03 PM

Document Has Been Signed on 02/29/2024 12:03 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:	J.S.D. STATE PRESCHOOL		FACILITY NUMBER:	410518055
ADMINISTRATOR:	ZIMIGA, LISA		FACILITY TYPE:	850
ADDRESS:	631 HANOVER ST., RM. 1 & 2		TELEPHONE:	(650) 991-1258
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY: 104	TOTAL ENROLLED CHILDREN: 75	CENSUS: 71	DATE:	02/29/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Geneva San Miguel		TIME COMPLETED:	12:15 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	On February 29, 2024 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced, annual inspection. LPA met with office administrator, Geneva San Miguel, and explained the purpose of the inspection. Director was not present during LPA's visit. Preschool program operates at General Pershing School and operates in classrooms #1, #2, #5 and #6. Present during LPA's visit included 11 staff and 71 children. Facility is operating within capacity limits and ratio during LPA's visit. All staff are fingerprinted through Jefferson Elementary School District. Program operates both full time and part time. Classrooms #1 and #2 operate 8:00am to 2:30pm. Classrooms #5 and #6 operate 8:30am to 12:00pm. LPA inspected the preschool classrooms and the outdoor area for health and safety hazards. LPA observed each classroom to have a variety of toys and materials that were in good working condition. Children's furniture and equipment were observed to be age appropriate. Activities in classrooms are separated into multiple areas that include writing, dramatic play, science, math and a quiet/rest space. Flooring in classrooms include rugs that were observed to be clean and secure to the ground. Storage for children's belongings are located inside the classrooms, labeled with children's individual names. LPA observed each classroom to be equipped with a fully charged fire extinguisher, emergency backpack with emergency supplies and a fire alarm system. LPA observed multiple carbon monoxide detectors on site. During visit, LPA tested one carbon monoxide detector that was observed to be working. Electrical outlets in classrooms are made inaccessible with child safety covers. LPA observed cleaning solutions, poisons and other chemicals to be inaccessible to children in classroom's high shelves. Cabinets in classrooms that do not have child safety locks did not include any hazardous materials or poisons. Each classroom includes at least one sink that was observed to be working. Sinks accessible to children do not provide water that is warmer than 120 degrees Fahrenheit. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: J.S.D. STATE PRESCHOOL	FACILITY NUMBER: 410518055
	VISIT DATE: 02/29/2024

NARRATIVE

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Classrooms #1 and #2 include a bathroom that was observed to be in working condition. Children in enrolled in classrooms #5 and #6 utilize bathrooms in the outdoor area. LPA observed children's bathrooms to be in working condition. Bathrooms include garbage bins with tight fitting lids and appropriate sanitation products.

Entire outdoor area is fully fenced and enclosed. There are play structures in the outdoor area that have resilient padding underneath. Children's outdoor toys are in good condition. Outdoor area includes storage sheds that children do not have access to. LPA did not observe any bodies of water on site.

Drinking water is available to children, both indoors and outdoors, with filtered water pitchers and cups. Water pitcher is refilled on site through classroom sinks and/or drinking fountains.

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.

Per office administrator, they are unsure as to when the facility completed the lead water testing. LPA referred facility representative to the Department website for lead: Lead
Toxicity Prevention and Water Testing Information.

Program provides a food service that is through the school district and is brought into each classroom. LPA observed program to utilize a paper sign in/out system. Each classrooms' sign in/out sheet is located inside each classroom. LPA also observed each classroom to have required licensing documents to be posted and available for review.

During today's visit, LPA reviewed five random children's files. Children's files were complete with a record of required immunizations, emergency and admission information. Lead teachers in each classroom have a CPR/First Aid certification that is current and will expire 12/2025.

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.
(Continue Report on Page 3...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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: J.S.D. STATE PRESCHOOL	FACILITY NUMBER: 410518055
	VISIT DATE: 02/29/2024

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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/

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 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 was cited a Type B citation for not completing lead testing requirements by due date of January 1, 2023. A plan of correction was discussed and appeal rights 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 the facility representative, Geneva San Miguel.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/29/2024 12:03 PM - It Cannot Be Edited

Created By: Catrina Quimbo On 02/29/2024 at 11:40 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: J.S.D. STATE PRESCHOOL	FACILITY NUMBER: 410518055
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/29/2024

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 interview and record review, the licensee did not comply with the section cited above by not completing lead testing by January 1, 2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/29/2024
	Plan of Correction
1 2 3 4	Facility to test their water fixtures used for drinking and food preparation no later than POC due date. LPA reminded facility representative must be completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA reminded facility representative lead testing must be completed by an ELAP certified laboratory.

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: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC809 (FAS) - (06/04)

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