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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210107755
Report Date: 01/29/2020
Date Signed: 01/29/2020 11:18:01 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:PARKSIDE PRESCHOOLFACILITY NUMBER:
210107755
ADMINISTRATOR:JONES, DAWNFACILITY TYPE:
850
ADDRESS:1000 SIR FRANCIS DRAKE BLVDTELEPHONE:
(415) 258-4644
CITY:SAN ANSELMOSTATE: CAZIP CODE:
94960
CAPACITY:45CENSUS: 33DATE:
01/29/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director, Dawn JonesTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kassandra Medrano conducted an annual comprehensive inspection. LPA met with director, Dawn Jones, the purpose of the inspection was explained. Analyst and Director toured the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children's records. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Days and hours of operation are: Monday-Friday, 7:30am-6pm
The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Smoke and Carbon monoxide detectors present and in working order, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation, Parents Rights, and Reporting Requirements. Posting requirements for site visits were also discussed. Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov. Director was reminded of Mandated Reporter Training available on CCLD website. Training must be renewed every two years at www.mandatedreporterca.com. Facility has current emergency/fire drills on record. There is no apparent health and safety risks, facility appears to be clean and well maintained. LPA will return for staff files, once the file cabinet is made accessible.
The following items need to be completed and returned to Licensing by 02/12/2020:
-PERSONNEL REPORT (LIC 500)
-EMERGENCY DISASTER PLAN (LIC 610)
-DESIGNATION OF FACILITY REPRESENTATIVE (LIC 308)

"NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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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