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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213006109
Report Date: 05/18/2023
Date Signed: 05/18/2023 01:31:16 PM


Document Has Been Signed on 05/18/2023 01:31 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) MARIN HEAD START LYNWOOD (PS)FACILITY NUMBER:
213006109
ADMINISTRATOR:LOMBARDI, KELSEYFACILITY TYPE:
850
ADDRESS:1320 LYNWOOD DRIVETELEPHONE:
(415) 883-3791
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:40CENSUS: 17DATE:
05/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sheila ChambersTIME COMPLETED:
01:45 PM
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On 5/18/2023, Licensing Program Analyst (LPA) Hanson Leong, made an unannounced annual visit to the child daycare facility listed above. The LPA was granted entry by one of the teachers, Sheila Chambers. The LPA explained the purpose of the visit to Ms. Chambers. All facility’s staff members have had their criminal background checks cleared by Guardian. The LPA observed five staff members supervising seventeen preschool children. Children's capacity and ratio requirements were observed to be in compliance,

LPA performed comprehensive inspections of the facility to look for possible threats to health and safety. The facility offers a first aid kit that is completely loaded with everything that is required for the treatment of wounds and other types of injuries. Toys, furnishings, and learning materials in all classes are age appropriate. The LPA observed that the playground equipment and outdoor furnishings are in very good shape. The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind. All poisons, cleaning products, and other potentially harmful substances have been stored in a location that is inaccessible to children. The building is equipped with smoke detectors, carbon monoxide detectors, fire extinguishers that are properly charged, centralized smoke alarms, and phones that are in working order.

Ms Chambers has stated that the facility does not house any firearms or other types of weapons.

The LPA observed that the facility posted the required documents. (i.e., license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities)

The LPA reviewed the files of five different children. All required forms were in the files of the five children.

The LPA reviewed the files of five different staff members. All required forms were in the files of the five staff members. Review of the training records shows that two staff members are current with their Pediatric First Aid / CPR training. ***See Page 2 for continuation***

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023
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) MARIN HEAD START LYNWOOD (PS)
FACILITY NUMBER: 213006109
VISIT DATE: 05/18/2023
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Continued, Page 2
The LPA reviewed the facility's emergency drill log. According to the facility’s emergency drill log, the facility's emergency drills are carried out monthly.

Based on interview, the LEAD water testing was completed on 11/2022, which is required for all licensed childcare facilities.

The Incidental Medical Services (IMS) policy was discussed with Ms. Chambers. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm



Ms. Chambers 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 the 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.

Ms. Chambers was informed about the Mandated Reporter training. In addition to AB1207 training required to complete every two years by all staff hired a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, Ms. Chambers was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A copy of this report, and the “Notice of Site Visit”, were given to Sheila Chambers. A “Notice of Site Visit” must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted, and the report was reviewed with Sheila Chambers.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023
LIC809 (FAS) - (06/04)
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