Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002202
Report Date: 04/07/2017
Date Signed 04/07/2017 11:07:47 AM

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:FACESSF - HAYES VALLEY CDC (INFANT)FACILITY NUMBER:
384002202
ADMINISTRATOR:BACSAFRA, APRIL O.FACILITY TYPE:
830
ADDRESS:305 BUCHANAN STREETTELEPHONE:
(415) 552-1535
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY:18CENSUS: 12DATE:
04/07/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:April BacsafraTIME COMPLETED:
11:15 AM
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LPA Ng made a random annual inspection visit to the facility at issue. LPA met with April Bacsafra with 6 staff and 12 infants, all staff were fingerprinted and cleared. Facility is an infant program center. There are no known guns or weapons within the facility. In the classroom Furniture and equipment are age appropriate. There is adequate heating, lighting and ventilation. Water is served via staff, drinking utensils were labeled, there is sufficient storage available for the children's belongings and sufficient space for the group size being served. All diaper changing stations and staff to infant ratios met regulatory standards. There are sufficient cribs and cots to meet the needs of the capacity. In the toileting areas, toilets flush, faucets work and sinks are reachable by children. Toilet paper, soap and towels are available and the bathrooms are clean. There is sufficient lighting and ventilation. Hot water was tested at 80.1 degrees F, this was tested after all children had washed their hands, it was also observed that staff assisted each child in washing their hands. There is a separate staff bathroom. In regards to food service, the facility provides Breakfast, Lunch, and snack to the older children, parents provide meals for younger infants, the food is prepared off site. There is a food prep kitchen area the, food items were inspected & no deficiencies were found refrigerator was observed to be operating at 35 degrees F., all kitchen equipment were working within guidelines of the law, and the kitchen was inaccessible to the children, the menu is posted. In the inspection of the outdoor area, the outdoor area does have a small play structure and was observed to be maintained. The flooring material is of soft rubber matting and concrete. In regards to health related services, the Site Director states medications may be dispensed if a parent provides note and also is a prescription no over the counters. Medication is stored in the upper cabinets, refrigerated medications will be placed on the upper shelves of the refrigerator. There are children currently on medications, children are greeted and checked for illness. There are first aid supplies and thermometer is available. There are Earthquake emergency items available at this visit. Isolation is provided in the office with the use of the staff bathroom if needed. In regards to the discipline policy used in the facility, the Director states that they use positive guidance and redirection. In regards to records, staff and children's files were reviewed. Facility has posted the required forms (i.e. License, menus, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). First Aid/CPR certification is current to 09/2018. A roster is available and the last drill conducted and logged was on 03/19/17. Sign in and out documents complied with regulations and was accurate.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2017
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: FACESSF - HAYES VALLEY CDC (INFANT)
FACILITY NUMBER: 384002202
VISIT DATE: 04/07/2017
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FACILITY IS PROVIDING IMS: 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 Family Child Care Homes Section 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. Facility will submit a written plan by the end of April. Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. All staff have updated required immunization record in file. Facility has one child using IMS, file was reviewed documents were available.


PESTICIDES:
Pesticide regulations were discussed with the director, In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. If the director had questions she can email ccipmlist@cdpr.ca.gov. Director was also advised that bleach is considered to be a pesticide under the law.

LPA also went over all new regulations with the Licensee ( IMS), immunization, Toddlers, Civil penalties, smoking prohibition, Pesticides (DPR.ca.gov), Carbon monoxide detectors and Childhood Nutrition training. LPA observed Site Director posting the Notice of Site Visit. The report was reviewed with the director and no deficiencies were observed in this visit.

ADVISORIES: Do not leave key on the door knob to staff restroom, Rocking horse must only be used where there is rubber padding (outside area). Place all immunization information on the PM286 form. All staff that does not have flu shot records must have a letter to opt out of the flu shot.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2017
LIC809 (FAS) - (06/04)
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