210102737-10-8-2019-05-CC-BVAN-BGRP5E-20191008110038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210102737
Report Date: 10/08/2019
Date Signed: 10/08/2019 11:00:51 AM

COMPREHENSIVE INSPECTION

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:	BELVEDERE NURSERY SCHOOL		FACILITY NUMBER:	210102737
ADMINISTRATOR:	PARKER, KATHLEEN		FACILITY TYPE:	850
ADDRESS:	15 COVE ROAD PLACE		TELEPHONE:	(415) 435-1661
CITY:	BELVEDERE	STATE: CA	ZIP CODE:	94920
CAPACITY:	45	CENSUS: 18	DATE:	10/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Kathleen Parker		TIME COMPLETED:	11:10 AM

NARRATIVE
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	On 10/8/19 at 8:45 A.M., Licensing Program (LPA) Van conducted an unannounced random inspection today and met with director, Kathleen Parker. The purpose of the inspection was explained and granted entry to the facility by the director. There are 18 preschool children present and 5 staff members. The facility meets teacher/child ratios. This is a pre-school program, operations hours are from 8:30 AM - 12:30 PM, Tuesday and Thursday, 8:30 AM - 3 PM on Monday, Wednesday and Friday. There are furniture & equipment age appropriate & in good repair. Heating, lighting & ventilation are adequate. Drinking water bottle is provided from home and readily available to children. Cubbies are used to store children's belongings. A single restroom is located in the center, there are three toilets and a large sink with three faucets. The restroom is clean, in good repair, and maintain adequate supplies. The water temperature is warm. There is a separate staff restroom. The isolation area for an ill child is located in the facility conference room. The toilet and sink designated for an ill child is in the staff restroom. Facility provides snacks. LPA observed the outside play area is completely fenced. There are no bodies of water, shade is provided. The play ground is free of hazardous materials. Play equipment is age appropriate, and safe. Drinking water is accessible water fountain. Facility provides Incidental Medical (IMS), LPA reviewed medications storage, and paperwork with director, and observed medications are properly labeled and stored. First aid supplies are available and well maintained. The emergency and earthquake preparedness plan are located near the front entry. The facility conducts emergency disaster drills quarterly, LPA observed the last drill was conducted on 10/3/19. Continue on the next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

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: BELVEDERE NURSERY SCHOOL	FACILITY NUMBER: 210102737
	VISIT DATE: 10/08/2019

NARRATIVE

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At 10:10 A.M., LPA reviewed personnel and children records. A sample of children's files were reviewed and found to have medical assessments, needs/services, and signed admission agreements. Staff files are organized, complete, and have documentation of education credits. Multiple staff members have record of valid CPR card in files and documentation of immunization for Measles, Pertussis and Influenza. LPA also observed 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).

LPA reminded the director 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. LPA observed the facility has record of required immunization for all staff members.

LPA reviewed AB 1207 with the director. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

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