213004686-2-16-2023-05-CC-NGAA-CP4UQK-20230216144716

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 213004686
Report Date: 02/16/2023
Date Signed: 02/16/2023 02:47:27 PM

Document Has Been Signed on 02/16/2023 02:47 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SAN GERONIMO VALLEY COMMUNITY CENTER CHILD CARE		FACILITY NUMBER:	213004686
ADMINISTRATOR:	CORT, DAVE		FACILITY TYPE:	840
ADDRESS:	6350 SIR FRANCIS DRAKE BLVD.		TELEPHONE:	(415) 488-8888
CITY:	SAN GERONIMO	STATE: CA	ZIP CODE:	94963
CAPACITY:	52	CENSUS: 0	DATE:	02/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:04 PM
MET WITH:	Nicole Ramirez		TIME COMPLETED:	03:15 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 February 16, 2023 at approximately 01:00 PM, Licensing Program Analyst (LPA) Nathan Garcia met with Site Director, Nicole Ramirez for an unannounced annual inspection. Purpose of the inspection was explained. There were no children present in the facility, the children are still in class and program starts at 3:00 PM. Facility operates day care Monday - Friday 3:00pm to 5:30pm. With Director, LPA inspected 2 day care rooms and the outdoor space. LPA observed facility has combined smoke detectors and carbon monoxide detectors, 2 fully charged fire extinguisher model 2A10BC 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. All food is stored properly to avoid contamination. Individual items provided by the parents are labeled and stored appropriately. According to Nicole, the facility serves PM snacks prepped and served at the facility. No lunches since it's an after school program. Per director, the children are provided through kitchen sink as main source of drinking water, as needed. The water is filtered through Brita water pitchers and water bottles are brought from home. Foods are nut-free and 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: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAN GERONIMO VALLEY COMMUNITY CENTER CHILD CARE	FACILITY NUMBER: 213004686
	VISIT DATE: 02/16/2023

NARRATIVE

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LPA observed outdoor area and play structures are free from health and safety hazards. The sand boxes are well maintained and checked/covered after each use. There are a variety of bicycles 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 Nicole, the facility has done the water lead testing with the Lagunitas School District. LPA was forwarded with the results and LIC forms, through email.

According to the director, the facility is using paper for sign in/out but are transitioning to use MyRec application. 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 January 31, 2023. Per Nicole, drills are done every 3-4 months.

The LPA reviewed the facility records. LPA did not review children's files because they were not present at the time. All required files were available in folders. LPA reviewed 4 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. The facility has a set learning curriculum that includes story time, and movement 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.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAN GERONIMO VALLEY COMMUNITY CENTER CHILD CARE	FACILITY NUMBER: 213004686
	VISIT DATE: 02/16/2023

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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 Manager, Nicole Ramirez.

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: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC809 (FAS) - (06/04)

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