210102822-6-28-2023-05-CC-NGAA-CT8QKA-20230628121400

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210102822
Report Date: 06/28/2023
Date Signed: 06/28/2023 12:14:09 PM

Document Has Been Signed on 06/28/2023 12:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	HAWTHORNE NURSERY SCHOOL		FACILITY NUMBER:	210102822
ADMINISTRATOR:	GISLADOTTIR, HRUNDA		FACILITY TYPE:	850
ADDRESS:	145 ROCK HILL DRIVE		TELEPHONE:	(415) 435-9757
CITY:	TIBURON	STATE: CA	ZIP CODE:	94920
CAPACITY:	45	CENSUS: 10	DATE:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Hrund Gisladottir		TIME COMPLETED:	12:25 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	On June 28, 2023 at approximately 10:15 AM, Licensing Program Analyst (LPA) Nathan Garcia met with Site Director, Hrund Gisladottir for an unannounced annual inspection. Purpose of the inspection was explained. There were a total of 10 children and 2 teachers present in the facility, the children were observed during outdoor play time. Facility operates day care Monday - Friday 9:00-12:30pm for the summer program and during the school year 8:30-2:30pm. With Director, LPA inspected day care rooms and the outdoor space. LPA observed facility has multiple smoke detectors and carbon monoxide detectors, 2 fully charged fire extinguisher model 3A40GR located on multiple areas and in each rooms. The facility has a working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards. There are first aid supplies available in the classrooms and in the office. All bathrooms are in working condition. Individual items provided by the parents are labeled and stored appropriately. According to Hrund, the facility serves morning snacks, all prepped and served at the facility. The parents provide food from home for lunch and PM snacks and all diet sensitivities are accommodated. Per director, the children are provided through kitchen sink as main source of drinking water, as needed. The kids mainly bring their water bottles from home. All food is stored properly to avoid contamination. Food preparation area is free of litter. Food is stored adequately to prevent contamination and properly labeled. There is water available for children in the yard as well as in the classrooms and emergency bags. *page 2 for continuation*

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAWTHORNE NURSERY SCHOOL	FACILITY NUMBER: 210102822
	VISIT DATE: 06/28/2023

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
26
27
28
29
30
31
32

***Page 2 continued***

LPA observed outdoor area and play structures are free from health and safety hazards. The outdoor area has a large yard with slides and structures within the sandbox. There are a variety of toys and sport equipment available for the children. There are also sheds/bins and storage areas for the toys when they're not being used.

According to Hrund, the facility has done the water lead testing for the preschool license, the test revealed that one of the kitchen sinks in the church next door is above the 5ppb limit of lead. The location of the sink is not part of the day care facility and the staff members know not to use that sink for refilling the Brita pitchers. LPA has the LIC forms and results on file.

According to the director, the facility is using paper sign in/out sheets. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log and last drill was conducted on February 2023. Per Hrund, drills are done at least every 6 months, rotating them between lock down/fire and earthquake drills. For napping, the children are provided blankets which are washed once a week on site.

The LPA reviewed the facility records. LPA reviewed 3 children's files that were present at the time. All required files were available in folders. LPA reviewed 2 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. The facility has a set learning curriculum posted in the classroom.

The Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption or transfer their existing clearance or exemption prior to initial presence in a Child Care Center.

A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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.

***Page 3 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAWTHORNE NURSERY SCHOOL	FACILITY NUMBER: 210102822
	VISIT DATE: 06/28/2023

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
26
27
28
29
30
31
32

***Page 3 Continuation***

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file.

LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

This facility provides Incidental Medical Services – IMS. According to the director, there are no children with allergies. 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

Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

Report was reviewed and signed by Site Director, Hrund Gisladottir .

Today’s report, and notice of site visit will be printed and given to the director.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3