<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210107755
Report Date: 03/04/2020
Date Signed: 03/04/2020 05:24:10 PM

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: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: 15DATE:
03/04/2020
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
03:48 PM
MET WITH:Director, Dawn JonesTIME COMPLETED:
05:30 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 March 4th,2020 at 3:48pm, Licensing Program Analyst (LPA) Kassandra Medrano made an unannounced annual continuation inspection. LPA met with Director, Dawn Jones.The purpose of the inspection was explained to her, to finish annual inspection and review staff files. Present today are 15 children, and 4 staff, Capacity and ratio requirements of children was observed in compliance today. Previous inspection was not completed due to jammed staff file. Reviewed during previous inspection were children files, and all were current and complete. The Analyst toured the facility building and grounds, conducted an evaluation of the physical plant. Facility appeared to be clean and in good repair. At 4pm, during review of staff records, director was able to provide LPA with files. At 4:50pm, during completion of file review, LPA observed that staff records were incomplete.








California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):

"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: 03/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020
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 2
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: PARKSIDE PRESCHOOL
FACILITY NUMBER: 210107755
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2020
Section Cited

1
2
3
4
5
6
7
101217 Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on record review and observation and conversation with director the files were incomplete. This poses a potential health and safety risk to children.
8
9
10
11
12
13
14

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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2