Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002210
Report Date: 02/14/2018
Date Signed 02/14/2018 02:11:23 PM

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:NELLIE KNOXFACILITY TYPE:
850
ADDRESS:649 DIAMOND STREETTELEPHONE:
(415) 400-4846
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94114
CAPACITY:10CENSUS: 8DATE:
02/14/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Kristin ScagliottiTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Huang met with Licensee Kristin Scagliotti for an Annual Random visit today. Purpose of the visit was explained to her. Facility has hired a New Director, Allie Smith, her paperwork has not updated to Licensing yet. Present at the facility were two Teachers with with 8 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. Facility uses a separate toilet and sink for staff in the church across street at the school; Classroom is clean, safe, and are set up with age appropriate furniture, equipment, and materials. Ventilation, heating and lighting are adequate. 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. Facility does not have children need IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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 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 (every year), pertussis(every 10 years), and measles( one time only)or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Please see deficiencies cited today under CCR,Title 22, Div. 12, Chapt. 1:
This report and rights to comment and appeal were discussed with the Licensee. This report must be kept in the facility available for public review. LPA Huang observed the Licensee posted the Notice of site visit today.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2018
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: PIXIE HALL STUDIOS (PS)
FACILITY NUMBER: 384002210
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2018
Section Cited
HSC
1596.7995&1597.662
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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.
Some staff does not have current required Immunization.
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Licensee will ensure all staff have current required immunizations by the due date: 3/14/18.
Influenza-every year or exempt
Pertussis-every 10 years
MMR-one time onl
Type B
02/28/2018
Section Cited
CCR
101212(b)
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Reporting Requirements. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence shall be reported to the Department with in 10 days of a change. Facility has a new Director, but paperwork has not submit to LPA Huang yet.
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Licensee will submit all the Director qualification paperwork to CCL by the due date, 2/28/18.
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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) 266-8800
LICENSING EVALUATOR NAME: Karen HuangTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2018
LIC809 (FAS) - (06/04)
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