Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002210
Report Date: 03/23/2016
Date Signed 03/23/2016 11:32:57 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:PIXIE HALL STUDIOS (PS)FACILITY NUMBER:
384002210
ADMINISTRATOR:KRISTIN SCAGLIOTTIFACILITY TYPE:
850
ADDRESS:649 DIAMOND STREETTELEPHONE:
(415) 400-4846
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY:10CENSUS: 9DATE:
03/23/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Kristin ScagliottiTIME COMPLETED:
11:45 AM
NARRATIVE
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#3: Licensing Program Analyst (LPA) Huang met with Teacher Aid Perle Crownover for an Annual Random visit today. Purpose of the visit was explained to her. The Director was not here. Staff text her to come, she came after about 30 minutes later. Present at the facility were also two other staff with with 9 children in care. Facility meets teacher/child ratio today. The indoor areas were inspected today for health and safety hazards. There is only one class room and a children's bathrooms on this site, with one toilet and one sink for children. There are separate toilet and sink for staff use in the church across street at the school; however, according to the staff, they were using the same bathroom as the children. Classroom is clean, safe, and are set up with age appropriate furniture, equipment, and materials. Ventilation, heating and lighting are adequate. Medication policy was discussed, it meets licensing regulations. Children bring their own lunch and the facility provides snacks only. First aid supplies are available for children in each classroom at the center. Emergency supplies are available at the Facility. Sick children will be separated from the group and place in the hallway by the bathroom while waiting for their parents to pick up. Facility has granted outdoor space waiver to use the outdoor play ground from across street, located at 665 Elizabeth Street, San Francisco, CA 94114. Facility shares this outdoor space with St. Phillip the Apostle School and has exclusive use between 9:45am to 10am when they licensed. Per Director, they have been going to the outdoor between 10am-10:30am now. Fire and Earthquake drills are done about every month. Staff has current CPR and First Aid training.

Please see deficiencies cited today under CCR,Title 22, Div. 12, Chapt. 1:

This report and rights to comment and appeal were discussed with director. This report must be kept in the facility available for public review. LPA Huang observed the Director Posted the Notice of site visit today.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8843
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3


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: PIXIE HALL STUDIOS (PS)
FACILITY NUMBER: 384002210
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/25/2016
Section Cited
101170(e)(2)
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Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline.
LPA observed staff #3 has criminal record clearance, but was not transferred to this facility.
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Licensee will ensure all staff have criminal record clearance transferred to the facility before start working with children. $100 civil penalty was accessed for this violation. Licensee filled out the form during the visit, and LPA Huang entered the transfer request in the LIS today. Deficiency is corrected today.
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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: Suzanne Roman-ClarkTELEPHONE: (650) 266-8843
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: PIXIE HALL STUDIOS (PS)
FACILITY NUMBER: 384002210
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2016
Section Cited
101215.1
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Child Care Center Directors Qualifications and Duties: Director must be at the facility full time.
Per Facility staff and LPA's observation, the Director is not at the facility full time.
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Per Director, she will submit paper work for one of the teacher to be the Director here full time. She will have paper work ready by the due date, 4/11/16.
Type B
04/11/2016
Section Cited
101216
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Personnel Requirements
LPA observed all the staff files were not completed.
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Licensee will ensure all staff files will be completed by the due date, 4/11/16.

A list of all paper work for teacher was provided today during the visit.
Type B
04/11/2016
Section Cited
101221(a)
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Child’s Records. The licensee shall ensure that there are separate, complete and current records kept for each child attending the child care center.
LPA observed that all children's files were not completed.
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Licensee will ensure all children's files will be completed by the due date, 4/11/16.

A list of all paper work for children was provided today during the visit.
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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: Suzanne Roman-ClarkTELEPHONE: (650) 266-8843
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3