214005125-2-27-2020-05-CC-FBTQ-BM6W4H-20200226155732

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005125
Report Date: 02/26/2020
Date Signed: 02/27/2020 08:28:31 AM

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: 33	DATE:	02/26/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Cristina Burrell		TIME COMPLETED:	04:00 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 met with site Director, Crisitina Burrell to conduct a required inspection on 2/26/20. Purpose of the inspection was explained. There were 33 school age children present with 5 staff. Program operates on Reed Elementary School site. Program operates M-F, 7 AM- 8:30 and 1:00 PM -6:00 PM during school days and 7 AM -6 PM on non-school days. Program operates in room 4 & 5 in the side building. Facility is a combination center with preschool program on the other side. Facility was complying to the required staff and child ratio on this day. Facility provides a snack and children bring their own lunch. Menus for the snacks were observed posted by the kitchen door. Facility was inspected indoors and outdoors for Health and Safety hazards. Facility uses one big classroom for the school age children. Preschool children of the school are in the side room , which is divided by a divider when children from both programs are present. Classroom have age appropriate toys and equipment that are in good repair. Hooks and cubbies are used to store children’s belongings and are located inside the classroom. Program uses the outdoor play yard at the front of the building. Children are not allowed to go beyond the set boundaries of the playground, unless supervised by Staff. Outdoor play area is free of debris and dangerous conditions. All outdoor toys and equipment are age appropriate and in good repair. Classroom is equipped with a smoke and carbon monoxide detector and a fire extinguisher. Classroom has proper ventilation and sufficient lighting. Both Boys’ and Girls’ restroom inside the classroom has 2 toilets and 2 sinks and are labeled with signs. Restrooms are maintained clean, in good repair, and with adequate supplies. First Aid Kit and Emergency supplies are properly maintained and kept inaccessible to children. Per facility's log, last drill for fire was conducted on 1/10/20 and earthquake on 12/9/19. Cleaning products and toxins are maintained inaccessible to children. 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 record contains the record immunization. Multiple staff members have record of valid CPR cards in files. Facility has an onsite kitchen, which is barricaded with a locked door. continuation on next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020

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
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: 02/26/2020

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

LPA reminded facility that All adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CDL or CA. ID prior to having any contact with children in care, failure to do so could result in an immediate civil penalty.

LPA reminded facility that As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. Multiple staff members have completed the training and LPA observed certificates in files. LPA encouraged the facility to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

>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 Director. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. Facility was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020

LIC809 (FAS) - (06/04)

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