214005477-12-20-2024-05-CC-NGAA-DC5SA9-20241220124159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005477
Report Date: 12/20/2024
Date Signed: 12/20/2024 12:42:26 PM

Document Has Been Signed on 12/20/2024 12:42 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:	HUMMINGBIRDS COLLABORATIVE SCHOOL		FACILITY NUMBER:	214005477
ADMINISTRATOR/ DIRECTOR:	RICHARD, MELINDA		FACILITY TYPE:	850
ADDRESS:	1990 NOVATO BLVD.		TELEPHONE:	(415) 760-6197
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY: 42	TOTAL ENROLLED CHILDREN: 42	CENSUS: 14	DATE:	12/20/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:17 AM
MET WITH:	Melinda Richards		TIME VISIT/ INSPECTION COMPLETED:	01:10 PM

NARRATIVE

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On December 20, 2024, Licensing Program Analyst (LPA) Nathan Garcia arrived at the facility and met with lead teacher, Carrie Barozzi for an unannounced annual/random inspection of the preschool facility. Purpose of the inspection was explained. There were 14 children in care and there were a total of 2 teachers. Facility operates day care program Monday- Friday from 7:30 AM through 5:30 PM. During the visit, Director, Melinda Richard arrived at the facility at 10:15 am. Another teacher arrived at approximately 10:21 am.

LPA inspected day care rooms, and the outdoor space. LPA observed facility has combined smoke/fire and carbon monoxide detector, multiple fully charged fire extinguisher model 3A40BC located in the classrooms. LPA did not test the functionality of the carbon monoxide detectors due to ceiling height. 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 classroom. The bathroom is in working condition, LPA checked sinks and toilets. Individual items provided by the parents are labeled and stored appropriately. Per Melinda, the facility provides Water through water services, refilled as needed. All food is stored properly to avoid contamination. LPA observed that there are a variety toys/books for the children to use.

LPA observed outdoor areas has age appropriate play structures with slides and swings are free from health and safety hazards. The outdoor area has shaded areas for the children to rest. The outdoor areas has spring riders to use and padded floors for the children. There are also sheds/bins and storage areas for the toys when they're not being used.

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Daniel J Oquendo	TELEPHONE: (650) 379-9023
Nathan Garcia	TELEPHONE: (650) 266-8800
	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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: HUMMINGBIRDS COLLABORATIVE SCHOOL	FACILITY NUMBER: 214005477
	VISIT DATE: 12/20/2024

NARRATIVE

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CCC SUBMITTED AN ATTESTATION LETTER AND CURRENTLY UNDER REVIEW:

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Based on record review, the facility submitted the lead water attestation letter and is currently under review.

According to staff, the facility is using paper for sign in/out. Facility has license and all other required documents posted and visible for the public. Facility completed their most recent emergency drill on November 15, 2024. Per staff, drills are done at least every 6 months rotating them between fire and earthquake drills.

LPA reviewed the facility records. LPAs reviewed 4 child's file during the visit. LPA reviewed 2 staff files with qualifying requirements such as ECE Units and Mandated Reporter Training.

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: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

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: HUMMINGBIRDS COLLABORATIVE SCHOOL	FACILITY NUMBER: 214005477
	VISIT DATE: 12/20/2024

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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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

According to staff, there are no children with allergies and LPA verified that the medications are valid. LPA observed that one asthma medication for C1 was expired.
Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. 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

See 809D for deficiencies cited during the visit.

A copy of this report was given with the “Notice of Site Visit” to the staff. 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 and signed by Director, Melinda Richard.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/11/2025 12:20 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/11/2025 12:13 PM

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: HUMMINGBIRDS COLLABORATIVE SCHOOL	FACILITY NUMBER: 214005477
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Section Cited

CCR

101216.3(a)

Teacher-Child Ratio

(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	*THIS IS AN AMENDMENT OF ORIGINAL REPORT DATED 12/20/24* *Deficiency has been modified from a TYPE A violation to a TYPE B violation.* Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. LPA observed a teacher was supervising 14 children while 1 staff steps out to use the restoom.
	POC Due Date: 12/23/2024
	Plan of Correction
1 2 3 4	The facility director and another staff member arrived during the visit making the facility compliant with teacher to child ratio. Deficiency cited today will be also be cleared.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Carol Marcroft	TELEPHONE: (650) 379-9023
Cindy Interiano	TELEPHONE: (650) 266-8800
	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/20/2024 12:42 PM - It Cannot Be Edited

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: HUMMINGBIRDS COLLABORATIVE SCHOOL	FACILITY NUMBER: 214005477
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed that the personnel files did not have any documentation of their MMR, TDAP and flu shots or declination forms.
	POC Due Date: 01/20/2025
	Plan of Correction
1 2 3 4	The facility will review the personnel records and ensure that the immunization records are on file.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Daniel J Oquendo	TELEPHONE: (650) 379-9023
Nathan Garcia	TELEPHONE: (650) 266-8800
	DATE: 12/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024

LIC809 (FAS) - (06/04)

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