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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005161
Report Date: 02/06/2020
Date Signed: 02/06/2020 01:06:28 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:UNIVERSITY OF PLAYFACILITY NUMBER:
213005161
ADMINISTRATOR:BALLENGER, SYLVIAFACILITY TYPE:
850
ADDRESS:1055 LAS OVEJAS AVE RM#4TELEPHONE:
(415) 499-0309
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:30CENSUS: 28DATE:
02/06/2020
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Alexis GrazioseTIME COMPLETED:
01:30 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
Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced to conduct Annual/Random Inspection today and met with Assistant Director, Alexis Graziose. Director sylvia wasn’t present today. Purpose of the inspection was explained. There were 28 children present with 5 staff. Facility was operating in compliance to the required ratio and capacity limits. LPA verified the background check clearance for all staff present today. Hours of operation are: M-F, 7:30 AM - 5:30 PM. Facility provides two snacks to children in care. Children bring their own meals if needed. Menus for the snacks were observed posted. Program operates in two classrooms, freshman and seniors.

LPA and Alexis inspected the facility indoors and outdoors for Health and Safety hazards. Classroom have age appropriate toys and equipment that are in good repair. Cubbies are used to store children’s belongings and are located in classrooms. Outdoor play area is free of debris and dangerous conditions. All outdoor toys and equipment are in good condition. Soft cushioning has been installed under play structure to prevent any falls or injuries. Classroom is equipped with a smoke detector, a carbon monoxide detector and a fire extinguisher. Classroom has proper ventilation and sufficient lighting. Facility has toilets available for the children in care in senior’s classroom. Toilets are maintained clean, in good repair, and with adequate supplies and proper sanitation. First Aid Kit and emergency supplies are properly maintained and kept inaccessible to children. Cleaning products and toxins are maintained in cabinets near sinks. LPA reviewed the facility records. LPA reviewed 8 random children's and all present staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Each child's file contains the record of immunization. At least one of the staff members present today have record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers present today. Facility has a log for emergency drills being conducted. Per log, last emergency drill was conducted in January 8, 2020.

During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Facility was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Facility was reminded about the Provider Information Notices (PINs) on CCLD website.
*Facility was reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)

>NO deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations. This report and rights to comment and appeal were discussed with Alexis. This report must be available in the facility for public review. Notice of site shall be posted for 30 days from today's visit. Facility 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
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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 1