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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210111538
Report Date: 05/10/2023
Date Signed: 05/10/2023 03:29:43 PM

Document Has Been Signed on 05/10/2023 03:29 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:C.A.M (CFS) HAMILTON (SA)FACILITY NUMBER:
210111538
ADMINISTRATOR:LOMBARDI KELSEYFACILITY TYPE:
840
ADDRESS:5520 NAVE DRIVETELEPHONE:
(415) 883-4385
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 47TOTAL ENROLLED CHILDREN: 15CENSUS: 13DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Valerie CarverTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced annual inspection. LPA met with Lead Teacher Valerie Carver and explained purpose of inspection. School age program operates in classroom 6 as part of a combination center along with preschool license #213001939 and infant license #213002658. Present in the program were the Lead Teacher, one teacher, and 13 school aged children. Center is operating within capacity limits and in compliance with staff to child ratio. Hours of operation are Monday to Friday from 7:30am to 5:30pm.

LPA inspected classroom with Lead Teacher. There are no bodies of water or firearms on the premises. Classroom is in good repair with proper temperature and ventilation and is free of any hazards. All furniture is in good condition. Classroom has age appropriate toys and equipment. All cleaning products, chemicals, and toxins are inaccessible to children. Outdoor play area is fenced in for supervision. Outdoor toys and equipment are age appropriate and in good condition. Play structure has adequate cushioning underneath.

All required postings are properly posted by the entrance of the room. School provides an afternoon snack. Food prep area of classroom is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. There is a bathroom with two toilets and one sink. There are two more sinks in the classroom available for children's use. Bathroom appears to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises.

Last emergency drill was conducted in April 2023. Emergency drills are conducted every month and are properly logged. Sign in/out is done by paper. Center has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system and a working telephone available on site. Room has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a first aid kit.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: C.A.M (CFS) HAMILTON (SA)
FACILITY NUMBER: 210111538
VISIT DATE: 05/10/2023
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Ten children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff have a criminal record clearance on file. Staff have current pediatric first aid/CPR certificates on file which expires on une 2023.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Facility representative was reminded, as of September 1, 2016, all staff and volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.

Facility representative was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff. Training can be taken online at www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (US DOJ) 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility representative 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.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: C.A.M (CFS) HAMILTON (SA)
FACILITY NUMBER: 210111538
VISIT DATE: 05/10/2023
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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with facility representative Valerie Carver.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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