214005125-7-2-2019-05-CC-BVAN-BDPR6E-20190702124437

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005125
Report Date: 07/02/2019
Date Signed: 07/02/2019 12:44:44 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:	BELVEDERE TIBURON CHILD CARE CENTER SCH. AGE		FACILITY NUMBER:	214005125
ADMINISTRATOR:	BURRELL, CRISTINA		FACILITY TYPE:	840
ADDRESS:	1185 TIBURON BOULEVARD		TELEPHONE:	(415) 435-4366
CITY:	TIBURON	STATE: CA	ZIP CODE:	94920
CAPACITY:	56	CENSUS: 19	DATE:	07/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Christina Burrell		TIME COMPLETED:	12:50 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) Van met with Executive Director, Christina Burrell for an unannounced annual inspection. The purpose of the inspection was explained. This is a school age center. The facility is located in a bungalow type building, it is a shared building with the preschool program. Staff to child ratio was met on this day. Days and hours of operations are from Monday - Friday 7:00 AM - 6:00 PM. With director, LPA inspected the day care areas. Variety of age appropriate toys and learning materials for children are available. Classroom is set up for child care; furniture, equipment, sufficient amount books for children are available. All children's chairs and table have rounded corner. Per director, there are no firearms or weapons at the facility. There are no pools, spas or other bodies of water at the facility. This center provides Incidental Medical Service (IMS). LPA reviewed storage and paperwork requirements with director. Facility has smoke detector, carbon monoxide detector, fully charged fire extinguisher and a working telephone at the site. All cleaning solutions, poisons and other chemicals that are dangerous stored inaccessible to children. Sick children will be separated from the group and will be waiting in staff's office for parents to pick up. The facility is clean, in good repair and free of any hazards. There are proper lightning, ventilation, and comfortable temperature. All bathrooms, toilets and sinks are clean and well sanitized. All solid waste bins have proper tight fitted lid on top. Facility has water fountains for drinking water available for children. Per director, facility does not or provides lunch to the children, only provides snacks. Outdoor playground area is in good repair. Swing sets and climbing structures are securely anchored, free of any loose parts and has sufficient amounts of pads under the play structures to prevent any fall injuries. Continue on the next page.....................................

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019

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: BELVEDERE TIBURON CHILD CARE CENTER SCH. AGE	FACILITY NUMBER: 214005125
	VISIT DATE: 07/02/2019

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
26
27
28
29
30
31
32

Continuation from previous page.....................................

LPA reviewed the staffs and children records. LPA observed that facility has sign in / out record with full legal signatures from parent or authorized representative. Multiple staff members have record of valid Pediatric First-Aid/CPR card in file. There are class schedule posted and are visible to the child's authorized representative. LPA also observed facility has posted the required forms (i.e. License, menus, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Director states Fire and Earthquake drills are done every two months, the last drill was logged on 6/28/19. Discipline is talking to the children, reminder, and redirection.

LPA reminded the director that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles. LPA observed the facility has record of required immunization of all staff.

LPA reviewed AB 1207 with the director. As of January 1, 2018, 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 training completion certificates of staff in the files.

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2