s3.amazonaws.com€¦FACILITY EVALUATION REPORT CCLD Regional Office, ... NARRATIVE Licensing...

('-, -( STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT CCLD Regional Office, 851 TRAEGER AVE., SUITE 360 SAN BRUNO, CA 94066

FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR:SUSAN IGNACIO-HAO, DIRECTR

FACILITY NUMBER: FACILITY TYPE:

414002733 850

{650) 755-8440 94014

11/19/2014 08:30AM 11:30 AM

ADDRESS: 398 "F" STREET TELEPHONE: CITY: COLMA STATE:CA

CENSUS: 24 UNANNOUNCED

ZIP CODE: CAPACITY: 68 DATE: TYPE OF VISIT: Annual/Random TIME BEGAN: MET WITH: Susan Hao TIME COMPLETED:

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

NARRATIVE

Licensing Program Analyst (LPA) Leung made an unannounced annual visit and met with the director, Susan Hao. Present during the visit is the director, 4 staff and 24 preschool children. The facility operates in three classrooms, Room 1 - Chicks (2 - 3 years old); Room 2 - Pandas (3 - 4 years old); Room 3 - Caterpillars ( 4 - 5 years old). Hours of operation: Monday- Friday from 7:00AM to 6:00PM. LPA toured the facility and observed the following: parents sign in children at the front lobby; children stay in Room 2 & 3 before 8:50am, then the youngest group go into the toddlers room #1. Children have morning snacks in their classroom. The facility is clean and free from any safety hazards. Furnishings and equipment appear to be clean and in good condition. Each classroom has it's own boys and girls bathrooms. The bathrooms are clean and free of any hazardous items. There is a separate bathroom for staff usage. There is water readily available indoor and outdoor for children. Fire extinguishers and first aid kits are available in each classroom. Children bring in their own lunches. Plenty of outdoor toys are available in the play yard. All staff have current First Aid/ CPR certificates. Last fire/ earthquake drill was conducted on 10/29/14, it was logged properly.

This report and a Notice of Site Visit were provided to Director Hao.

SUPERVISOR'S NAME: Wes Beecham TELEPHONE: {650) 266-8843

TELEPHONE: {650) 266-8843 LICENSING EVALUATOR NAME: Garfield Leung

LICENSING EVALUATOR SIGNATURE: lit

DATE: 11/19/2014

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

FACILITY REPRESENTATIVE SIGNATURE:

~~ DATE: 11/19/2014

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LICB09 (FAS)- (06/04) Page: 1 of 1

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STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAO, DIRECTR ADDRESS: 398 "F" STREET CITY: COLMA CAPACITY: 56 TYPE OF VISIT: Case Management MET WITH: Susan Hao, John Sittner

STATE:CA CENSUS:O ANNOUNCED

NARRATIVE

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CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office, 801 TRAEGER AVE., SUITE 100 SAN BRUNO, CA 94066

FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED:

414002733 850

(650) 755-8440 94014

08/29/2013 01:00PM 04:35PM

1 Licensing Program Analyst (LPA) Leung conducted an increase of capacity visit with Site Director Susan Hao 2 and Licensee John Sittner. This facility has requested an increase of 12 children to a total capacity of 68. 3 Today is a Staff Development Day, there are no children on site. Staff are busy cleaning and setting up for 4 the children to return on 9/3/2013. There are three classroom with 3 separate section of play yard. All three 5 classes rotate to use the play yards. LPA measured all classrooms since the set up has been rearranged. 6 The new measurement of the classrooms ·are 2,390 sq. ft., it will accommodate 68 children indoor. There are 7 no changes for the outdoor space. Children's bathrooms have a total of 11 toilets and 12 faucets. There is a 8 diaper changing station in the Toddlers room #1. A new fire clearance request has been sent out by 9 Licensing. 10 11 Upon receipt of Fire Department approval for the new 68 capacity, an increase of capacity license will be 12 recommended. 13 14 This report was discussed and provided to Director Hao. 15 16 17 18 19 20 21 22 23 24 25

SUPERVISOR'S NAME: Wes Beecham

LICENSING EVALUATOR NAME: Garfield Leung

LICENSING EVALUATOR SIGNATURE:

~

TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 08/29/2013



~ 1~ DATE: 08/29/2013


LIC809 (FAS)- (06/04) Page: 1 of 1

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STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

0



This is an official report of an unannounced visiUinvestigation of a complaint received in our office on 08/10/2012 and conducted by Evaluator Alma Malig

FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR:SUSAN IGNACIO-HAO, DIRECTR ADDRESS: 398 "F" STREET CITY: COLMA CAPACITY: 47

MET WITH: SUSAN IGNACIO-HAD

ALLEGATION(S): 1 I Lack of Supervision 2 3 4 5 6 7 8 9

INVESTIGATION FINDINGS:

COMPLAINT CONTROL NUMBER: 05-CC-20120810084009

FACILITY NUMBER: FACILITY TYPE: TELEPHONE:

STATE: ZIP CODE: CENSUS: 28 DATE: UNANNOUNCED TIME VISIT BEGAN:

TIME COMPLETED:

414002733 850

(650) 755-8440 94014

08/17/2012 10:45 AM 12:30 PM

1 Licensing Program Analyst Alma Malig condcuted a 10 day complaint visit this day and met with Site Director, 2 Susan Hao. LPA explained the purpose of the visit. Today there are 4 staff with 28 children, facility meets 3 teacher /child ratio. Susan states the incident happened during napt time with a substitute teacher. Although 4 the bathroom are located inside the classroom, Susan states staff are intructed to allow one child at a time to 5 go to the bathroom and must supervised children in the bathroom and in classroom by standing at the door. 6 This staff did not follow the procedure. Based on the information from complainant, child and facility, this 7 incident did occurr therefore complaint allegation, determine as Substantiated. 8 9 1 0 This report is discussed and explained to Susan Hao. This report will be kept in the facility file for public review 11 upon request. 12 Type A violations are issued today. Licensee is advised to post and provide copies of this report to parents and 13 guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for

the next next 12 months. All parents shall sign the LIC 9224 as proof of receipt.

Substantiated Estimated Days of Completion:

SUPERVISOR'S NAME: Sue Humbert-Rico

LICENSING EVALUATOR NAME: Alma Malig


TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 08/17/2012

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


DATE: 08/17/2012

This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04) Page: 1 of 2

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Control Number 05-CC-20120810084009 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

FACILITY NAME: EARLY LEARNING ACADEMY DEFICIENCY INFORMATION FOR THIS PAGE:

Deficiency Type POC Due Date I DEFICIENCIES Section Number

101229(a)(1) Care and Supervision. No child(ren) 1 shall be left without the supervision, including

Type A 2 visual observation, of a teacher at any time except

08/17/2012 3 as specified in sections 101216.2(e)(1) and

Section Cited 4 101230(c)(1). 5

1 01229(a)(1) 6 2 children were in the bathroom without staff 7 supervision.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1

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FACILITY NUMBER: 414002733 VISIT DATE: 08/17/2012

PLAN OF CORRECTIONS(POCs)

Facility Director, states she has met with all staff with signed and acknowlegement to reiterate the

2 regulation Care and Supervision. No child(ren) 3 shall be left without the supervision, including 4 visual observation, of a teacher at any time. 5 Director shall submit Plan of Correction to LPA by 6 8/24/12. 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

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: Sue Humbert-Rico



TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 08/17/2012

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


kA..~tAt.~ ~ DATE: 08/17/2012

This Notice must be posted for 30 days Page: 2 of2

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STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT CCLD Regional Office, 801 TRAEGER AVE., SUITE 100 SAN BRUNO, CA 94066

FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAO, DIRECTR


414002733 850

(650) 755-8440 94014

06/27/2012 09:00AM 10:40 AM

ADDRESS: 398 "F" STREET TELEPHONE: CITY: COLMA STATE:CA

CENSUS: ZIP CODE:

CAPACITY: 47 DATE: TYPE OF VISIT: Case Management UNANNOUNCED TIME BEGAN: MET WITH: Aike Wong TIME COMPLETED:

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

NARRATIVE Licensing Program Analyst Alma Malig conducted a Case Management visit this day and met with StC!ff in charge Aike Wong in the absence of the Director. Susan- Director is on vacation. LPA explained the purpose of the visit. aike states there is no additional classroom for an increase capacity request of 65. Aike states The facility has requested a preschool capacity of 65 children aged 2-6 years old. The facility is currently licensed for 4 7 children. Facility still operates in 3 classrooms with the same number of toilets and sink. Facility days and hours of operation: Monday-Friday 7:00am-6:00pm. Outdoor play area is adjacent to the classrooms and is securely fenced. Facility phone# 650-755-8440.

This facility was previously measured. Indoor area measures 1978.39 square feet allowing for a capacity of 56 children. Outdoor play area measures 7012.50 square feet allowing for a capacity of 93 children. See facility sketch and capacity worksheet completed on 12/08/10. There is a changing tables next to the sinks in the children's bathrooms in Room#1. There are separate toilets and sinks for staff use. Isolation area for ill child is in the Director's office which ill child will use the staff bathroom with a toilet and sink. Fire clearance granted on 12/07/10 for a capacity of 47 children was received at PRO 12/08/10. Today facility can approved the increase of capacity request to 56 children and Fire Clearance is required.

Facility is adequately furnished with age appropriate toys, furniture, equipment, First Aid supplies, and napping equipment. Mats and bedding will be labeled and stored separately in the storage cabinets above the cubbies in each classroom. There is a separate kitchen but food will be catered in. Earthquake/fire drills will be conducted once/month and logged. Medications will be stored in the staff lounge and will be logged. Water is available in/outdoors and will be provided by water pitcher and Igloo. There is adequate shade and climbing structures with soft cushioning. Prior to approving the increase of capacity request; Fire Clearance is required.

SUPERVISOR'S NAME: Sue Humbert-Rico TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843 LICENSING EVALUATOR NAME: Alma Malig


l DATE: 06/27/2012



~ "-'"~ DATE: 06/27/2012


LIC809 (FAS) • (06/04) Page: 1 of 1

0 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

PROOF OF CORRECTION(S)

FA~c;;7 '-' Le Ct r t11 ,· r1~ A-ctt-d e nt

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LICENSING EVALUATOR

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING

Mahva~h Behbt;dd This form shall be used in conjunction with the Licensing Report (LIC 809) and is provided to the facility to verify the correction

of deficiency(ies) cited in a licensing visit to your facility on 2/ / J /fin . The use of this r (DA E)

form will not prohibit the Licensing Evaluator from conducting follow-up visits to ensure that deficiencies are corrected. (See

instructions on back of this form).

DEFICIENCV(IES) 'OF IUN DATE SECTION NUMBER PICTURE RECEIPT PHOTOCOPY *CERTIFICATION OTHER CORRECTED

1. to t:Loo {c) £/ cl/t ~ 2.

3.

4.

5.

6.

7.

8.

9.

I certify, under penalty of perjury under the laws of the State of California, that the above is true and correct and that I have corrected all deficiencies above on or before the date(s) indicated.

'--7./uv *Certification - This box rl\ay be checked if there is no other means to verify that the deficiency has been corrected. By signing this form, the licensee is self-certifying that the corrections have been made. If the certification is related to fingerprints, include the name(s) of the individual(s) for which the fingerprint card was submitted and insert the date submitted to the Department of Justice in the "Date corrected" column.

LIC 9098 (4/09)

RECEl\/r;D '

FEB 0 6 2012 COMMUNI 1 Y CARt: UCEI~SING PENINSULA R.O. -CHILD CARE

PLEASE RETURN THIS FORM WITH YOUR PROOF OF CORRECTION(S)

PAGE1 OF2

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STATE OF CAI,IFORNIA ·HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)



1 A teacher-child ratio of one teacher supervising 24

Type A 2 napping children is permitted provided that the

3 remaining teachers necessary to meet the overall 02108/2012 4 ratio specified in Section 101215.3(a) are

Section Cited 5 immediately available at the center. A teacher was 101230(c) 6 with 17 children during nap time, another teacher

7 was in another classroom with 12 children no other staff was immediately available at the center

1 2 3

Section Cited 4 5 6 7

1 2 3


1 2 3


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1 effective immediately the ratio during nap time

2 must be as regular If there is no other staff

3 available. An statement from licensee must be

4 received by the 02/08/2012 stating she will remain

5 in compliance with ratio during nap time. 6 .

7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

Failure to correct the cited deflciency(ies}, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Wes Beecham

LICENSING EVALUATOR NAME: Mahvash Behbood


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TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8866

DATE: 02/01/2012



~ A.;1 fJJ AA lhAAJ This Notice must be posted for 30 days

LIC809 (FAS) • (0&104)

DATE: 02/01/2012

RECEIVED Page: 2 of2

FEB 0 6 2012 COMMUNiTY CARE LICENSING PENINSULA R.O. - CHILD CARE

.. 0

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~~

0

February 2, 2012

Community Care Licensing,

We were cited yesterday for not having another teacher immediately available at the center during nap time.

Our plan of correction is to continue to have two teachers supervising between the two nap rooms and I will be the other staff immediately available at the center during nap time.

12:30- 1 :20- Aike Wong, Zoila Martinez or Menchy Marpuri & Susan Hao

1 :20- 2:30- Zoila Martinez, Menchy Marpuri & Susan Hao

~~ Susan Hao Director

Early Learning Academy 398 F Street, Colma, CA 94014

RECEiVED fEB 0 6 2012

CO.ViMUNITY CARE UCENSING PEN11\J3ULA R.O. -CH!U) CAR:=

Web: www.EarlylearningAcademy.org * Telephone: (650) 755-8440 * Facsimile: (650) 755-9472

~


CCLD Regional Office 801 TRAEGER AVE., SUITE 100 SAN BRUNO, CA 94066

03/09/2012

EARLY LEARNING ACADEMY 414002733 PO BOX636 SALT LAKE CITY, CA 84110

Letter of Deficiency Citations Cleared Dear Licensee,

(\


The following deficiencies, initially cited during a visit on 02/23/2012, have been cleared:

Section Cited: 101229(a)(1) Plan of Correction: Effective immediately all children must be visually supervised all the time. A written plan of correction should be received no later than 03/02/2012.

Section Cited: 1 01223(a)(2) Plan of Correction: By providing proper supervision the chance of children's personal rights being violated is far less likely, therefore the above written plan of correction will correct this citation.

LICENSINGl:VALUATOR NAME: Mahvash Behbood


Date Due: 03/02/2012 Corrections: requested document received

Date Due: 03/02/2012 Corrections: equested document received

Clearance Date: 03/09/2012

Clearance Date: 03/09/2012

TELEPHONE: (650) 266-8866

DATE: 03/09/2012

This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) - (04/05) Page: 1 of 1

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FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR:SUSAN IGNACIO-HAO, DIRECTR ADDRESS: 398 "F" STREET CITY: COLMA CAPACITY: 47 TYPE OF VISIT: Case Management MET WITH: Susan lgnacio-Hao

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STATE:CA CENSUS: 31 UNANNOUNCED


414002733 850

(650) 755-8440 94014

04/05/2012 03:00PM 05:25PM

NARRATIVE 1 Licensing Program Analyst Alma Malig conducted a Case Management visit this day due to an Unusual 2 Incident occurred on 03/21/12 for a possible Lack of Supervision. 03/21/12@ 4:45 Child's father came to 3 report of what daughter said to him of what happened at school this day. Child told father that another child 4 have touched his/ her private. Staff Ms Zoila asked when and where did it happened? No response from 5 child. When asked Where and When did the incident happened, child did not respond, so father told teacher 6 what child said and just to keep an eye on her. On 03/22/12, child's grand aunt spoke with Facility Director, 7 Susan of the incident. Director asked Grandaunt if child told her where and when did this incident happened 8 and what time? child told grandaunt it happened in the classroom the day before while they were playing/ 9 horsing around and another child touched her private. Director called the Mother and asked what if any did 10 her child told her. Mother states child told her another child touched her but will not say inside and did not say 11 when. There is no additional information the Director is able to obtain from the child. Staff did not witnessed 12 or observe any of these. Facility has 1 to 10 ratio for 2 and 3 yrs old. Part time staff comes in the morning to 13 help out the 2 yr old class. There is 1 to 12 ratio in the 4 year old class. Director interviewed the child in 14 question, no information was obtain. Children are talked to about inappropriate touching specially private 15 parts of their body. Staff are also reminded constantly about supervision at all times. LPA inspected the 16 classrooms for health and safety hazards and none noted in today's visit. Classrooms set up without any 17 obscured area where children can hide. Entire classroom can be supervised by staff. Child is still enrolled in 18 the facility. 19 20 No deficiency cited. 21 22 23 24 25




t'J2fVti.

TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 04/05/2012



~~ DATE: 04/05/2012


LIC809 (FAS) • (06/04) Page: 1 of 1

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COMPLAINT INVESTIGATION REPORT

(-



This is an official report of an unannounced visit/investigation of a complaint received in our office on 12/28/2011 and conducted by Evaluator Mahvash Behbood

FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAG, DIRECTR ADDRESS: 398 "F" STREET CITY: COLMA CAPACITY: 47

MET WITH: Susan lgnacio-Hao

ALLEGATION(S): 1 I Violation of Personal Rights 2 Lack of supervision 3 4 5 6 7 8 9

INVESTIGATION FINDINGS:

COMPLAINT CONTROL NUMBER: 05-CC-20111228141538

STATE: CENSUS: 34 UNANNOUNCED

FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED:

414002733 850

(650) 755-8440 94014

02/23/2012 12:00 AM 01:00PM

1 A final visit was made to deliver the findings of the investigation regarding the above allegations. Met Susan 2 Hao, Site Supervisor. The purpose of the visit and the findings were discussed. During the course of this 3 investigation children, staff, and the parents were interviewed, facility teacher child ratio were evaluated, 4 supervision was observed. Based on the information obtained, it has been determined lack of supervision was 5 existed and therefore a child's personal rights were violated. This complaint investigation is closed as 6 Substantiated. 7 8 Please see next page for deficiency cited under CCR, Title 22, Sec. 6, Chapter 1: 9 10 Type A violations were issued today. Licensee is advised to post and provide copies of this report to parents 11 and guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility 12 during the next 12 months. All parents shall sign the LIC 9224 as proof of receipt 13

Substantiated

SUPERVISOR'S NAME: Wes Beecham



~~~v ·------------

Estimated Days of Completion:

TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8866

DATE: 02/23/2012



~~ 7~/l/0 DATE: 02/23/2012

This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page: 1 of3

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Control Number 05-CC-20111228141538 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)



1 Care and Supervision. No child(ren) shall be left

Type A 2 without the supervision, including visual

03/02/2012 3 observation, of a teacher at any time except as

Section Cited 4 specified in sections 101216.2(e)(1) and 5 101230(c)(1). A child was inappropriately touched

1

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FACILITY NUMBER: 414002733 VISIT DATE: 02/2.3/2.012


Effective immediately all children must be visually 2 supervised all the time. A written plan of correction 3 should be received no later than 03/02/2012. 4 5

101229(a)(1) 6 by another child, staff were unaware of the incident 6 7 7

1 Personal Rights. Each child shall be accorded 1 By providing proper supervision the chance of Type A 2 safe, healthful and comfortable accommodations, 2 children's personal rights being violated is far less

03/02/2012 3 furnishings and equipment. A child was 3 likely, therefore the above written plan of correction

Section Cited 4 inappropriately touched by another child which 4 will correct this citation. 5 violated the child's personal rights. 5

1 01223(a)(2) 6 6 7 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

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: Wes Beecham TELEPHONE: (650) 266-8843



TELEPHONE: (650) 266-8866

'?17 r DATE: 0212.312.012



j~ 1JM DATE: 02/23/2012

This Notice must be posted for 30 days

LIC9099(FAS) ·(06/04) Page: 2of2

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FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAO, DIRECTR ADDRESS: 398 "F" STREET CITY: COLMA CAPACITY: 47 TYPE OF VISIT: Case Management MET WITH: Aike Wong

f'




STATE: CA ZIP CODE: CENSUS: 21 DATE: UNANNOUNCED TIME BEGAN:

TIME COMPLETED:

414002733 850

(650) 755-8440 94014

05/20/2011 09:00AM 10:30 AM

NARRATIVE 1 Licensing Program Analyst Alma Mlaig condcuted a Case Management visit this day and met with staff in 2 charge Aike Wong. Site Director is out today. LPA explained the purpose of the visit. This visit is due to an 3 Unusual Incident ocurred on 05/03/11, 3 yr old child was playing and bumped his head on one of thC? play 4 structure. LPA and Aike toured and inspected the facility for health and safety hazards. There are 4 staff with 5 21 children present today. LPA inspected the out play area structures. Facility wrapped and foamed all the 6 joints of the play structure to prevent any injury. Today, the outdoor play area appears safe and there are no 7 visible hazards noted in today's visit. During the incident, staff observed what happened and took necessary 8 action and notified parents child returned the next day. Based on the information obtained by this LPA, there 9 are no supervision issue. No deficiency cited. 10 11 This report is expalined and discussed with Aike. 12 13 14 15 16 17 18 19 20 21 22 23 24 25




TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 05/20/2011



~ ~~ DATE: 05/20/2011

1r 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 1

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FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR:SUSAN IGNACIO-HAO, DIRECTR ADDRESS: 398 "F" STREET

0


PENINSULA CHILD CARE, 801 TRAEGER AVE., SUITE 100 SAN BRUNO, CA 94066


CITY: COLMA CAPACITY: 47 TYPE OF VISIT: Prelicensing


ZIP CODE: DATE: TIME BEGAN:

414002733 850

(650) 755-8440 94014

12/08/2010 01:30PM 05:15PM MET WITH: Susan lgnacio-Hao TIME COMPLETED:

NARRATIVE 1 Licensing Program Analyst Alma Malig conducted a Pre Licensing inspection visit this day and met with the 2 Business Mgr- John Sittner and Site Director, Susan Hao. This is a change of location previously licensed at 3 474 San Diego St. Daly City Ca. fac# 414001748. The facility has requested a preschool capacity of 47 4 children aged 2-6 years old. The facility is located at the Bridge Housing in City of Colma. Facility will operate 5 on the lower (street level) of the Building. Facility has 3 classrooms. Classroom #1 has as bathrooms with 3 6 sink and 3 toilets. Classroom #2 has 4 sink and 4 toilets. Classroom #3 has 3 sink and 4 toilet. Facility days 7 and hours of operation: Monday-Friday 7:00am-6:00pm. Outdoor play area is adjacent to the classrooms 8 and is securely fenced. Facility phone# 650-755-8440. 9 10 Indoor and outdoor space was measured and inspected today for health and safety. Indoor area measures 11 1978.39 square feet allowing for a capacity of 56 children. Outdoor play area measures 7012.50 square feet 12 allowing for a capacity of 93 children. See facility sketch and capacity worksheet. There are 10 sinks, 11 13 toilets, for children's use. There is a changing tables next to the sinks in the children's bathrooms in Room#1. 14 There are separate toilets and sinks for staff use. Isolation area for ill child is in the Director's office which ill 15 child will use the staff bathroom with a toilet and sink. Fire clearance granted on 12/07/10 for a capacity of 47 16 children was received at PRO 12/08/10. The maximum capacity facility could be licensed for today is 47 17 children. 18 19 Facility is adequately furnished with age appropriate toys, furniture, equipment, First Aid supplies, and 20 napping equipment. Mats and bedding will be labeled and stored separately in the storage cabinets above 21 the cubbies in each classroom. There is a separate kitchen but food will be catered in. Earthquake/fire drills 22 will be conducted once/month and logged. Medications will be stored in the staff lounge and will be logged. 23 Water is available in/outdoors and will be provided by water pitcher and Igloo. There is adequate shade and 24 climbing structures with soft cushioning. 25 LPA requested for facility to install a sensor alarms that sound when the exit door in classroom #1 is opened

and the gate in play area #1 leading into the street. Sound alarms were installed and tested during the visit.




TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 12/08/2010



~AA.~~-~ DATE: 12/08/2010


LIC809 (FAS) • (06/04) Page: 1 of2

('· ('

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT (Cont) PENINSULA CHILD CARE, 801 TRAEGER AVE,, SUITE 100 SAN BRUNO, CA 94066

FACILITY NAME: EARLY LEARNING ACADEMY FACILITY NUMBER: 414002733 VISIT DATE: 12/08/2010

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 26 27 28 29 30 31 32

NARRATIVE

continued from page 1 ..

Sign-in/out is at the receptionist table in the entry hallway outside the Office of the Director. Facility meets all the posting requirements: PUB 393 Parent's Rights poster 12/06, LIC 613 Personal Rights, LIC 610 Emergency Disaster Drill, LIC 9148 Earthquake Preparedness Ck list, Car Seat Law, Menu, Daily Activity Schedule.

Prior to Licensure:

License will be recommended for this facility effective 12/09/2010. Records to be Maintained at the Facility, LIC995(12/06) Parent's Rights, LIC9224 Acknowledgement of Receipt of Licensing Reports, LIC9182 Criminal Background Clearance Transfer Request, and LIC9188 Criminal Record Exemption Transfer Request was left at the facility was left at the facility. Reviewed record-keeping requirements and availability of required forms and regulations on-line at http://ccld.ca.gov

Self Assessment guides are at http://ccl.dss.cahwnet.gov/ChildCareS 1941.htm

This report was reviewed with .... A copy of this report must be available for public review.




TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 12/08/2010



~~-~ DATE: 12/08/2010

LIC809 (FAS) • (06/04) Page: 2 of2

~ STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AG

r CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

FACILITY VISIT SUMMARY REPORT Complaint Control Number:

TYpE OF VISIT

Complaint fn Prelicensing 0 Management

0 Random

0 POC

0 Required ~:z::~d I

DEFICIENCY/CIVIL PENALTY INFORMATION

0 Type A 0 Civil Penalty Assessed

0 Type 8 0 Penalty Notice Given 0 No Deficiency Cited 0 Penalty Cleared

AREA OF DEFICIENCY(IES)

0 Limits of License 0 Program/Operation

FACt?!~

CENSUS

-tr DA7 f)/?/!V

rf. Announced IT'7:3D TIME COMPLETED

0 Unannounced b:!J---

0 Penalty Not Cleared

0 Deficiencies Cleared 0 Deficiencies Not Cleared

0 Staffing/Ratio 0 Criminal Record 0 Records

0 Health Related/Medical Services

0 Physical Plant

0 Care and Supervision

0 Personal Rights

0 Food Service 0 Qualifications 0 Other

To Be Corrected By Date

<, ./~~~ '-.../ ('/~ v,t\ l-Q~/'-' "l=!fCOlV...__ 'f')T7 /--d'V'~ JCJ----,/T ~

·CD -------------------- DATE

lc have read and understand the el~ronic version of the full licensing report completed today at this facility. I acknowledge

eceipt of this form and understand my appeal rights as explained on the back of this form. If "A" violations are cited, child ;are providers must post this report pending receipt of final report.

~ -1-rt:vc '!

E WHEN PROVIDING A PRINTED COPY OF THE ELECTRONIC REPORT TO THE LICENSEE:

I certify that the attached · a/rue and correct copy of the electronic field visit report completed at the facility

on /( 0 /0 ~ . (Da e)

-.. ___ _ Lh(qtJ ~· (Date)

: BOSS (8/04) PAGE 1 OF2

/ ·'""· ;· r


PROOF OF CORRECTION

FACILITY NAME: FACILITY NUMBER:

EARLY LEARNING ACADEMY 414001748

('


Peninsula R.O., 801 Traeger Ave #100 San Bruno, CA 94066

LICENSING EVALUATOR:

Timothy Lee

This form shall be used in conjunction with the Licensing Report (LIC 809) and is provided to the facility to verify the

correction of deficiency(ies) cited in a licensing visit to your facility on 09/28/2007. The use of this form will not

prohibit the Licensing Evaluator from conducting follow-up visits to ensure that deficiencies are corrected. (See

instructions on page 2).

PROOF OF CORRECTION

- .. - .. .OEF!.C!E..I\!CX(~ESJ--..--~ __ E'.ICTUR_£ _RECEJPT PHOTO- *CERTIFICATION _on:~~ DATE

SECTION NUMBER COPY ~CORRECTED .

1. to l£.2tfa) v" 9/~ 8/{:}f

2. IO/J3i·o?(e) v .; 10 /J~jtJ-) I

3.

4.

5.

6.

7.

8.

9. .

I certify, under penalty of perjury under the laws of the State of California, that the above is true and correct and that I have corrected all deficiencies above on or before the date(s) indicated.

E O~LICENSEBFACI~~TIVE DATE " I --+ _!0_1 £/()l

*Certification - this box may be checked if there is no other means to verify that the deficiency has been corrected. By signing this form, the licensee is self-certifying that the corrections have been made. If the certification is related to fingerprints, include the name(s) of the individual(s) for which the fingerprint card was submitted and insert the date submitted to the Department of Justice in the "Data Corrected" column.

LIC9098 (FAS) • (3/00)

PLEASE RETURN THIS FORM WITH YOUR PROOF OF CORRECTION(S)

lQ:: ('';: ,; \ ;' ··'·'' ... ~ '\ b= !,.j lb~· 9 ~~

i4·c·T 1 f·' ')11['~1-· u . 1 ~ ~J l·:~}},

CO!VHViUt,JITY PEf~lNSUL.t\ r

Page: 1 of 2

0 r

STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

FACILITY EVALUATION REPORT Peninsula R.O., 801 Traeger Ave #100 San Bruno, CA 94066

FACILITY NAME: EARLY LEARNiNG ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAG


414001748 850

(650) 755-8440 94014

09/28/2007 03:00AM 04:30AM

ADDRESS: 474 SAN DIEGO AVENUE TELEPHONE: CITY: DALY CITY STATE:CA

CENSUS: 17 UNANNOUNCED

ZIP CODE: CAPACITY: 47 DATE: TYPE OF VISIT: Annual/Random TIME BEGAN: MET WITH: Susan Hao TIME COMPLETED:

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

NARRATIVE This annual random visit was conducted by LPA Tim Lee with director Susan Hao. There were 17 children in care with 4 teachers when LPA arrived. Facility meets teacher/child ratio today. Variety of age appropriate toys and materials for children are available in the classrooms. Classroom is set up for child care, furniture and equipment for children are available as well. Toxins and harmful objects are kept inaccessible to children. Medication policy was discussed, it meets licensing regulations. The center provides meals and is prepared at the center. LPA Lee inspected the refrigerator and there was no expired food in it. First aid supplies are available in each classroom. There were napping equipment available for children at the center. Isolation area will be in the director's office. Staff is aware of child abuse reporting requirements, and procedure. Statement Acknowledging Requirement to Report Suspected Child Abuse is kept in staff records. At least one staff has current pediatric CPR and First Aid training. There are front play yard and the back play yard. The children will use both yards where has a play structure with no rubberized cushioning in the front yard, basketball hoop in the back yard and etc. Facility has posted the required forms (ie License, menus. waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Fire and Earthquake drills are done each month and are properly logged. Separate confidential reports are available for children and staff record. Children's roster is not updated and Site Director has updated during the visit. No toxins or visual hazards was observe~

See next page for deficiency cited against the facility 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. Records to be maintained sheet was provided and explained to director. Notice of site visit was posted. She was also informed that licensing forms and regulations are available thru the Department's website: www.ccld.ca. A copy of LIC9224 was provided to director during the visit today to inform parents about the type A deficiencies cited today.

SUPERVISOR'S NAME: Happy Stuart

LICENSING EVALUATOR NAME: Timothy Lee


TELEPHONE: (650) 266-8823

TELEPHONE: (650) 266-8843

~)~· ~/ y~

DATE: 09/28/2007


FACILITY REPRESENTATIVE SIGNATURE: //

/'/'

/1{)1/L/VL/rt- ~ DATE: 09/28/2007


LIC809 (FAS) • (06/04) Page: 1 of 2

0


FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: EARLY LEARNING ACADEMY

DEFICIENCY INFORMATION FOR THIS PAGE:


1 Playground equipment- cushioning. LPA Lee Type A 2 observed that the play structure where the child

10/15/2007 3 was injured in 1/07 in the front yard has no

Section Cited 4 cushio;Jing. 5

101238.2(e) 6 7

1 Children's roster- facility shall keep an updated Type B 2 current children roster. Current roster is not

09/28/2007 3 available today.

Section Cited 4 5

101221 (a) 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1

0





Site Director, Susan Hao, agreed to install 2 cushioning around the play structure by due date. 3 LPA will inspect the correct by due date. 4 5 6 7

1 Site director has updated and corrected the 2 children's roster today. POC is corrected during the 3 visit. 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.




C) , ·1 -=--·-· ~-:/., I

-="'"'"- v / " . .,.

TELEPHONE: (650) 266-8823

TELEPHONE: (650) 266-8843

DATE: 09/28/2007



~~ '7~ DATE: 09/28/2007

This Notice must be posted for 30 days

LIC809 (FAS) • (06/04) Page: 1 of 1

('



FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAO ADDRESS: 474 SAN DIEGO AVENUE CITY: DALY CITY CAPACITY: TYPE OF VISIT: MET WITH:

47 Case Management Susan Hao

STATE:CA CENSUS: UNANNOUNCED

NARRATIVE

f'




414@@lt48 850

(650) 755-8440 94014

09/28/2007 04:37PM 05:40PM

1 LPA Lee conducted a case management visit today and met with Site Director, Susan Hao and there were 2 four teachers with 17 children. LPA inspected the front play yard and the back play yard. LPA Lee interviewed 3. the teacher name Zoila Martinez who witness the incident. She saw the child hit his forehead on the corner of 4 the play structure and started bleeding. LPA observed that the play structure is not cushioned which may 5 cause hazards to children playing around the play structure. LPA advised Site Director, Susan to install 6 cushioning around the corners of the play structure by Oct 15, 2007. Proof of Correction will be by 7 photographs or actual visit. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25




/~

TELEPHONE: (650) 266-8823

TELEPHONE: (650) 266-8843

DATE: 09/28/2007



;~7~Kv DATE: 09/28/2007

This report must be availe<ble at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) • (06104) Page: 1 of 1

0



FACILITY NAME: EARLY LEARNiNG ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAO ADDRESS: 474 SAN DIEGO AVENUE CITY: DALY CITY CAPACITY: 47 TYPE OF VISIT: Case Management MET WITH: Susan Hao

STATE:CA CENSUS: UNANNOUNCED

NARRATIVE

0




414001748 850

(650) 755-8440 94014

09/28/2007 03:37PM 04:45PM

1 LPA Lee conducted a case management visit today and met with Site Director, Susan Hao and there were 2 four teachers with 17 children. LPA inspected the front play yard and the back play yard. LPA Lee interviewed 3 the teacher name Zoila Martinez who witness the incident. She saw the child hit his forehead on the corner of 4 the play structure and started bleeding. LPA observed that the play structure is not cushioned which may 5 cause hazards to children playing around the play structure. LPA advised Site Director, Susan to install 6 cushioning around the corners of the play structure by Oct 15, 2007. Proof of Correction will be by 7 photographs or actual visit. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25




--"O~~L- ~ ~~

TELEPHONE: (650) 266-8823

TELEPHONE: (650) 266-8843

DATE: 09/28/2007

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


;iv~ ~-~~ DATE: 09/28/2007


LIC809 (FAS) • (06/04) Page: 1 of 1

(\



FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAO ADDRESS: 474 SAN DIEGO AVENUE CITY: DALY CITY CAPACITY: 47 TYPE OF VISIT: Case Management- Incident MET WITH: Susan Hao

STATE:CA

0



FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE:

CENSUS: DATE:

414001748 850

(650) 755-8440 94014

09/28/2007 04:37PM 05:40AM

UNANNOUNCED TIME BEGAN: TIME COMPLETED:

NARRATIVE 1 LPA Lee conducted a case management visit today and met with Site Director, Susan Hao and there were 2 four teachers with 17 children. LPA inspected the front play yard and the back play yard. LPA Lee interviewed 3 the teacher name Zoila Martinez who witness the incident. She saw the child hit his forehead on the corner of 4 the play structure and started bleeding. LPA observed that the play structure is not cushioned which may 5 cause hazards to children playing around the play structure. LPA advised Site Director, Susan to install 6 cushioning around the corners of the play structure by Oct 15, 2007. Proof of Correction will be by 7 photographs or actual visit. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25




'-7~~.L-~/<a:~~---~..,;._-

TELEPHONE: (650) 266-8823

TELEPHONE: (650) 266-8843

DATE: 09/28/2007



~~~ DATE: 09/28/2007


LIC809 (FAS) • (06/04) Page: 1 of 1

0



FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAO ADDRESS: 474 SAN DIEGO AVENUE CITY: DALY CITY CAPACITY: 47 TYPE OF VISIT: Case Management MET WITH: Susan lgnacio-Hao


NARRATIVE

0


Peninsula R.O., 801 Traeger Ave #1 00 San Bruno, CA 94066


414001748 850

(650) 755-8440 94014

07/24/2007 09:00AM 09:30AM

1 Licensing Program Analyst (LPA) made an unannounced visit today as a follow up to an unsual incident 2 report ( Lie 624) received. The facility self reported an incident involving a child that had fallen from a play 3 structure and hit his mouth on a table. LPA Inspected the outdoor area for any potential Health and Safety 4 Hazards. The play equipment is placed properly allowing ample space between items. There is no apparent 5 hazards during today's visit. No deficiencies are cited today. 6 7 This report was discussed with Susan lgnaicio-Hao, Director. This report must be made available for public 8 review upon request for three years. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25


LICENSING EVALUATOR NAME: Justina Mancillas


~~

TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 07/24/2007



~~.M-~ DATE: 07/24/2007


LIC809 (FAS) • (06/04) Page: 1 of 1

;-,



FACILITY NAME: EARLY LEARNING ACADEMY ADMINISTRATOR: SUSAN IGNACIO-HAO ADDRESS: 474 SAN DIEGO AVENUE CITY: DALY CITY CAPACITY: 47 TYPE OF VISIT: Case Management MET WITH: Susan lgnacio-Hao


NARRATIVE

('-




414001748 850

(650) 755-8440 94014

07/24/2007 09:00AM 09:30AM

1 Licensing Program Analyst (LPA) made an unannounced visit today as a follow up to an unsual incident 2 report (Lie 624) received. The facility self reported an incident involving a child that had fallen from a play 3 structure and hit his mouth on a table. LPA Inspected the outdoor area for any potential Health and Safety 4 Hazards. The play equipment is placed properly allowing ample space between items. There is no apparent 5 hazards during today's visit. No deficiencies are cited today. 6 7 This report was discussed with Susan lgnaicio-Hao, Director. This report must be made available for public 8 review upon request for three years. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25


LICENSING EVALUATOR NAME: Justina Mancillas


TELEPHONE: (650) 266-8843

TELEPHONE: (650) 266-8843

DATE: 07/24/2007


FACil~IV;r;;:tit -~ . DATE: 07/24/2007


LIC809 (FAS) • (06/04) Page: 1 of 1

("\ 0

STATE OF CAUFORNIA ·HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION

FACILITY EVALUATION REPORT Peninsula R.O., 801 Traeger Ave. #100 San Bruno, Ca, CA 94066

FACILITY NAME:

EARLY LEARNING ACADEMY FACILITY NUMBER: 414001748

DIRECTOR: SUSAN IGNACIO-HAC 474 SAN DIEGO AVENUE DALY CITY

FACILITY TYPE: 850 (650) 755-8440

94014 ADDRESS: TELEPHONE: CITY: ZIP CODE:

CAPACITY: 43

STATE:CA

CENSUS: 29 ANNOUNCED

DATE: 08/16/2005 10:00 AM TYPE OF VISIT: Case Management TIME BEGAN:

MET WITH: Susan Ignacio-Hac TIME COMPLETED:

DEFICIENCY INFORMATION FOR THIS PAGE: CIVIL PENALTY INFORMATION: No Deficiency Cited Not Applicable

COMMENTS/DEFICIENCIES

LPA Pat Fang with Susan Ignacio-Hac-site director for an announced case management visit. Facility was issued a Provisional License 4/14/05 for 43 preschool children. Facility was inspected today for health and safety hazards. No apparent hazards were observed during today's visit. Facility has made some physical plant changes to try to increase their indoor space to allow for a greater capacity. The changing table, double doors between the two classrooms, and some of the cubbies were removed. Indoor space now measures 1653.6 square feet, allowing for a capacity of 47 children. Outdoor space remains at 2744.94 square feet allowing for a capacity of 36 children. Fire clearance granted 4/14/05 for a capacity of 68 children was received at PRO. The maximum capacity facility could be licensed for today is 47 children.

Waiver request for scheduled use of out door play space received today.

After supervisor's review, a license will be recommended for this facility. Reviewed record-keeping requirements and availability of required forms and regulations on-line at http://ccld.ca.gov Self Assessment guides are at http://ccl.dss.cahwnet.gov/Self-Asses 2031.htm

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

This report was reviewed with Susan Ignacio-Hac. Advised of right to comment and appeal. A copy of this report must be available for public review. LIC9213 Notice of Site Visited posted.


SUPERVISOR'S NAME: Sharon Howell

LICENSING EVALUATOR NAME: Pat Fang

LICENSING EVALUATOR SIGNATURE: ____ -...l.., ...;.·-=..:..." -n------I acknowledge receipt of this form and unde

TELEPHONE: (650)266-8836

TELEPHONE: (650)266-8843

as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:£/J..J/l«A., !()!{~ -/flqATE: 08/16/2005

UCB09 (FAS)· (06/04) Page: 1 of 1

@

~~

~


DETAIL SUPPORTIVE INFORMATION

0


Peninsula R.O., 801 Traeger Ave. #100 San Bruno, Ca, CA 94066

This form is intended to document information that is relevant to the licensing file but generally not public information, such as collateral visits. This would include back-up information on deficiencies such as conditions contributing to the severity of violations, witnesses to the violations, or other observation from field notes. When used to support the Licensing Report (LIC809) the form should be completed, signed and dated shortly after the visit. This assures accuracy and completeness of the detail of the public report.

FACILITY NAME:

EARLY LEARNING ACADEMY

FACILITY NUMBER:

414001748

1 4/12/05 call from john sittner (650)756-4737. 2

DATE{S) OF VISIT:

04/12/2005

COLLATERAL VISIT?

0 Yes e No

~ fire inspector said he will definitely come out this week to do fire inspection and doesn't foresee any

5 problems as facility recently passed their annual ccc inspection. · 6 . 7 john and director-susan ignacio-hao reviewed their current enrollment to see what they can do to get 8 their capacity down to 43. wednesday is their highest census day - usually 57 children in care. other 9 days vary from 52-55 depending on morning or afternoon sessions. they have 8 two-year-olds not yet 10 potty trained. they have 15-16 five-year-olds that will graduate/leave 6/15/05. 11

~~he asked if we would allow him to give the 8 two-year-olds until 5/31/05 to either become potty trained

14 or be dropped from their program. he would like to change their program to require children be potty

15 trained before enrollment but keep age range of 2 to 6 years old. 16 17 discussed above with lum-sharon howell: as soon as we receive fire clearance i can give provisional 18 license to expire 6/30/05. 19 20 called john sittner back and told him sharon approved provisional license upon receipt of fire ~~clearance. then he will not be adding sink for changing table. after 5/31/05 he will remove changing

23 table and some of the unneeded cubbies to try to add as much additional usable space as possible.

24 he may also remove the double doors between the 2 classrooms as i did not measure/include doorway 25 as useable space. i will then do a second prel and add new space back into their total capacity. new 26 tan bark will be added under play structures this week .. he has all 184 documents i requested and will 27 hand deliver them this week along with the fire clearance. he will update parent handbook to say that 28 children must be potty trained before enrollment 29 30 pfong 31 32 33 34 35

LICENSING EVALUATOR NAME: Pat Fong

LICENSING EVALUATOR SIGNATURE: Po,-~v~

LIC812 (FAS) (PERSONAUCONFIDENTIAL DEPENDING ON TYPE OF INFORMATION)· (4/96)

TELEPHONE: (650)266-8843

DATE: 04/12/2005

Page: 1 of 1

~

(\


r

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNilY CARE LICENSING DMSION

Peninsula R.O., 801 Traeger Ave. #100

FACILITY EVALUATION REPORT San Bruno, Ca, CA 94066

FACILITY NAME:

EARLY LEARNING ACADEMY FACILITY NUMBER: 414001748

DIRECTOR: SUSAN IGNACIO-HAO, DIRECTR 474 SAN DIEGO AVENUE

FACILITY TYPE: 850 ADDRESS: TELEPHONE: (650) 755-8440 CITY:· DALY CITY STATE:CA ZIP CODE: 94014

CAPACITY: 68 CENSUS: 40 DATE: 04/07/2005 TYPE OF VISIT: Prelicensing ANNOUNCED TIME BEGAN: 01:15PM MET WITH: John Sittner & Susan lgnacio-Hao TIME COMPLETED: s-;oopM

DEFICIENCY INFORMATION FOR THIS PAGE: CIVIL PENALTY INFORMATION: No Deficiency Cited Not Applicable

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

COMMENTS/DEFICIENCIES

LPAs Pat Fong and Karen Huang met with John Sittner-applicant and Susan lgnacio-Hao-site director for an announced prelicensing visit. The facility has requested a preschool capacity of 68 children aged 2 to 6 years old. Hours of operation are Monday-Friday 7:00am-6:00pm. Outdoor play area is adjacent to classroom and is securely fenced. This is a change of ownership for Facility# 410506380 - Early Learning Academy (ELA) initially licensed 4/09/1985 for a preschool capacity of 63 children. ELA is continuing operation until date John Sittner is licensed. He is assuming ownership and use of all existing supplies and equipment. There is no change in use of either the indoor or outdoor space as currently licensed to ELA. Susan lgnacio-Hao is the current site director for ELA and will continue as site director for John Sittner. All ELA staff will continue to work for new owner.

Review of the prior facility's file shows no evidence that the facility was ever measured or how a capacity of 63 was determined when the prior facility was initially issued a license. Indoor and outdoor space was measured and inspected today for health and safety hazards. No apparent hazards were observed during today's visit. Indoor space measures 1526.4 square feet, allowing for a capacity of 43 children. Outdoor play area measures 2744.94 square feet allowing for a capacity of 36 children. See facility sketch and capacity worksheet. There are 5 sinks and 5 toilets available for children's use, allowing for a capacity of 75 for sinks and 75 for toilets. There is one changing table without a sink in arm's reach. There is a separate toilet and sink for staff use. Isolation area for ill child is in the director's office. The maximum capacity facility could be

licensed for today is 43 children. Fire clearance will determine final maximum capacity.

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: Sharon Howell TELEPHONE: (650)266-8836


LICENSING EVALUATOR SIGNATURE: , '-' • ..,_. )'( 1 ,r ....___.- ~v' {

I acknowledge receipt of this form and unders

FACILITY REPRESENTATIVE SIGNATURE: V "'\' Is\~ DATE: 04/07/2005

LIC809 (FAS) - (06/04) Page: 1 of1

r,;···) ~

" .__; (\ 0

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION

Peninsula R.O., 801 Traeger Ave. #100 San Bruno, Ca, CA 94066 FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: EARLY LEARNING ACADEMY DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 04/07/2005 No Deficiency Cited

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 26 27 28 29 30 31 32

NARRATIVE/COMMENTS

Facility is adequately furnished with age appropriate toys, furniture, equipment, First Aid supplies, and napping equipment. Bedding is labeled and stored separately in each child's cubby. Cots/mats are stored in the storage closets in room 2. There is a separate kitchen. Earthquake/fire drills are conducted once/month and logged. Medications are logged and stored in the refrigerator in the kitchen. Water is provided for the children in/outdoors. There is adequate shade and climbing structures with some tan bark cushioning.

3rd 184 Notification of Incomplete Application handed to John Sittner today. Staff present: director-Susan lgnaci'Snd teachers-Tammy Lim, Zoila Martinez, Petra Miranda, Aura Lila Rodriguez, Aike Wong, Substitute teacher-Sandra Cordova

Prior to Licensure: 1. Obtain Fire Clearance 2. Submit all items requested on LIC184 to complete application 3. Submit request for waiver for scheduled use of outdoor play space 4. Install a sink next to the changing table in Room 1 5. Add more tan bark under climbing structures

A follow-up visit will be made to ensure completion of above.

Upon completion of above, and after supervisor's review, a license will be recommended for this facility. A copy of Records to be Maintained at the Facility and LIC9182 Criminal Background Clearance Transfer Request information was left at the facility. Reviewed record-keeping requirements and availability of required forms and regulations on-line at http://ccld.ca.gov Self Assessment guides are at http://ccl.dss.cahwnet.gov/Self-Asses 2031.htm

This report was reviewed with John Sittner. A copy of this report must be available for public review.


SUPERVISOR'S NAME: Sharon Howell TELEPHONE: (650)266-8836


LICENSING EVALUATOR SIGNATURE: • - ·-, ---;-c, ..,_1_ ,,,

I acknowledge receipt of this form and unde

FACILITY REPRESENTATIVE SIGNATURE: I -)IV ::...?"5, I. II o

DATE: 04/07/2005

LIC809 (FAS) - (06/04) Page: 2 of1

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