210102822-6-27-2019-05-CC-BVAN-BDJQ97-20190627115752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210102822
Report Date: 06/27/2019
Date Signed: 06/27/2019 11:58:04 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:	HAWTHORNE NURSERY SCHOOL		FACILITY NUMBER:	210102822
ADMINISTRATOR:	WILSON, LAUREL		FACILITY TYPE:	850
ADDRESS:	145 ROCK HILL DRIVE		TELEPHONE:	(415) 435-9757
CITY:	TIBURON	STATE: CA	ZIP CODE:	94920
CAPACITY:	45	CENSUS: 12	DATE:	06/27/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Laurel Wilson		TIME COMPLETED:	12:00 PM

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	Licensing Program Analyst Van conducted an announced random annual inspection and met with director, Laurel Wilson. LPA explained the purpose of the inspection. The facility is a preschool program center. The facility is located on the top of Rock Hill Drive in the Congregational Community Church. Present there are 4 teachers and 12 children today. Facility meets Teacher/Child ratio. Facility is running a summer schedule today, for summer the operations hours are from 9:00AM - 12:30PM Monday - Friday. Regular school operations hours are 8:30AM - 12:30PM Monday - Friday, and on Tuesday/Thursday school offers extended hours to 3PM. LPA observed that facility has sign in / out record with full legal signatures from parent or authorized representative. Director and LPA inspected the center for health and safety hazards. The center is clean and orderly. Heating, lighting and ventilation are adequate. There are no pools, spas or other bodies of water on the premises. Per director, there are no firearms or weapons at the center. All cleaning supplies or other potentially harmful items are stored inaccessible to the children in care. This center provides Incidental Medical Service (IMS). LPA reviewed storage and paperwork requirements with director. The furniture and equipment are in good repair and is free from loose sharp or pointed parts. The center provides snack to children. The facility has more than one carbon monoxide detector and smoke alarm installed. Drinking water is provided to the children by water bottles brought from home. Cubbies are used to store children's belongings, and each cubby has child’s name labeled. The restrooms are located in each classroom all restroom facilities are 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 library area. The outside play area is completely fenced, clean and in good repair. The playground is free of hazardous materials. Play equipment is age appropriate, and safe. Climbing structures are securely anchored, free of any loose parts and has sufficient amounts of rubber cushioning floor to prevent any fall injuries. There are no bodies of water, shade is provided for children, and the sand box is inspected daily. Drinking water is accessible by water bottles. 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: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

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: HAWTHORNE NURSERY SCHOOL	FACILITY NUMBER: 210102822
	VISIT DATE: 06/27/2019

NARRATIVE

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LPA reviewed teachers 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. Scheduled activities are posted. LPA also observed facility has posted the required forms (i.e. License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Director stated Fire and Earthquake drills are done once every six months, last logged 10/18.

LPAs 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. LPA observed all staff members completed the online training, and certification are in file.

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: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

LIC809 (FAS) - (06/04)

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