Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002241
Report Date: 05/17/2017
Date Signed 05/17/2017 11:51:49 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:CCFC-VV TUCKER CENTER (P)FACILITY NUMBER:
384002241
ADMINISTRATOR:FONDA DAVIDSON, EXEC. DIR.FACILITY TYPE:
850
ADDRESS:103 TUCKER AVENUETELEPHONE:
(415) 921-7019
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94134
CAPACITY:40CENSUS: 27DATE:
05/17/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Kim ChanTIME COMPLETED:
12:20 PM
NARRATIVE
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#2 Licensing Program Analyst (LPA) Mok, conducted an unannounced annual inspection today. LPA met with the site director, Kim Chan, and Cross Culture Curriculum Specialist, Cynthia Elekwachi. The purpose of the inspection was explained to them. There were 16 children with 3 staff in upper classroom, and 11 children with 2 staff in lower classroom present. The center had 2 classrooms (upper and lower classrooms), and outdoor play area was adjacent to both classrooms. The operation hours were Monday to Friday from 8:30am to 5:30pm. LPA toured the facility for health and safety hazard. The gate at the main entrance was locked. Parents had to buzz by the gate before they entered the center. The classrooms were clean and in order. All toxins and harmful objects were locked or made inaccessible to children. There was a mid-size fish tank with tide lid sitting on a little table in upper classroom. Cubbies were available to children to store their own belongings. There were plenty of age appropriate toys, books, learning material, and children's furniture available for children. There were the water and sand tables available in upper classroom. Tap water was available and served with cups in each classroom. There was an adjacent children room in each classroom. The children bathroom was clean, and free of dangerous items in each classroom. There was a staff bathroom available in lower classroom that was next to a site director office. All electrical outlets were covered. Outdoor play area was completely fenced. There were plenty of age appropriate outdoor toys, water table, big sand box, and play structure with soft cushioning underneath. Fire and disaster drills have been conducted monthly. The latest drills were conducted in 4/2017. First Aid supplies were available in each classroom. Per Site Director, there were 2 children on special medication. This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative record. 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. Facility already submitted IMS to CCL for all the sites they have. At least one staff had current CPR/First Aid training; it will expire in 9/2017 . Weekly menu was posted in each classroom. Licensee provided breakfast, lunch, and AM/PM snack. All required documents were posted. Children roster and files were reviewed during inspection. Staff files were reviewed during inspection as well.

*See next page of a deficiency that was cited today.*

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2017
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: CCFC-VV TUCKER CENTER (P)
FACILITY NUMBER: 384002241
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2017
Section Cited
101239 (h)
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Fixtures, Furniture, Equipment and Supplies:

*Faucet on the left didn't work in children's bathroom in the upper classroom.*
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Based on the total licensed capacity, one toilet and one handwashing fixture shall be maintained for every 15 children, or fraction thereof. Facility shall fix the faucet by the due date (5/31/2017).
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2017
LIC809 (FAS) - (06/04)
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