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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005529
Report Date: 02/12/2021
Date Signed: 03/02/2021 08:54:04 AM

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:PAPERMILL CREEK CHILDREN'S CORNERFACILITY NUMBER:
214005529
ADMINISTRATOR:LOURDES ROMOFACILITY TYPE:
850
ADDRESS:1 FORREST WAYTELEPHONE:
(415) 663-9114
CITY:INVERNESSSTATE: CAZIP CODE:
94937
CAPACITY:15CENSUS: 0DATE:
02/12/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Lourdes RomoTIME COMPLETED:
01:30 PM
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Licensing Program Analyst's (LPA's) Glenn Schnell and Catrina Quimbo met with Applicant Lourdes Romo today for a pre-licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is requesting 18 children (ages 2 years to entry into first grade). The facility will operate Monday - Friday; 8:30 AM to 4:00 PM. The program is located on the campus of Shoreline Unified School District. The CA Dept. of Education has approved this school district to operate on that campus during the COVID-19 Pandemic. The designated director/site supervisor for the facility is Alisa Lamp. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: Classroom 3 will be used for the program and the following square footage was calculated for the room: 913.263 sq ft. Total useable indoor square footage is 913.263 sq ft divided by 35 sq ft equals 26 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There is storage space for children's personal belongings and cots to be utilized for napping children. Parents will provide a sheet and blanket for their child, bedding will sent home to be laundered weekly. Cots will be cleaned at least weekly or more often if needed. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, garbage cans (tight fitting lids not observed), first aid and emergency supplies. The first aid kit is observed incomplete. Report continues on the next page.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021
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 4
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: PAPERMILL CREEK CHILDREN'S CORNER
FACILITY NUMBER: 214005529
VISIT DATE: 02/12/2021
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The facility is adequately ventilated and free of insects and bugs. Window screens are in good repair. The parents will provide all snacks and lunch due to COVID-19. The facility will plan to provide lunch and snacks in the future. There is a full size kitchen located on the campus of the other preschool program also licensed to this applicant, located at 503 B Street, Point Reyes Station, CA 94956. The applicant plans to use this kitchen in the future to prepare lunch and snack food and transport it to this location to be served. Allowances for this were discussed. Only disposable products (cups, napkins, paper plates/bowls) will be used for food service since the facility is not set up to provide adequate sanitization of dishes and utensils. No foods are currently stored at this location.

Medications will be stored inaccessible to the children; applicant plans to purchase a refrigerator and lock box to stored medications. There are 4 toilets (one urinal is being counted as an additional toilet (60 capacity) and 3 sinks (45 capacity) accessible for children's use. There is a child size sink located in the classroom. Bathrooms are located outside of the classroom and will be shared with the elementary school. Applicant will submit a waiver request with a plan to share the bathrooms. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees. The program will provide a pitcher with water and cups for children to drink water indoors. All toxins and other hazardous items will be stored in a locked cabinet in the classroom and will be inaccessible to children. Isolation of ill children will be located in the office of the elementary school completely away from other children during COVID-19 and the staff bathroom will be used for an ill child.
Report continues on the next page.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: PAPERMILL CREEK CHILDREN'S CORNER
FACILITY NUMBER: 214005529
VISIT DATE: 02/12/2021
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Outdoor: The outdoor area measures 9000 sq ft. allowing for a total of 120 children. The outdoor space of the elementary school is completely fenced in and this program will be using outdoor space that is also used by a transitional kindergarten, kindergarten and a first grade class operated by the school district. The campus is completely enclosed with fencing, however, due to the size of the space, staff will use orange cones to mark the areas of the outdoor space that will be used by this preschool program. None of the other classrooms will use the outdoor space at the same time the preschool program will use the outdoor space. A waiver has been approved for scheduled rotational outdoor space usage. The outdoor area to be used is observed to be clean, safe and equipped with toys and equipment for children. There is a large climbing structure that is questionable in height and could present a hazard to preschool age children. Applicant did not have specifications about the structure from the manufacturer of the equipment to determine age appropriateness during todays' inspection. Applicant agrees to not allow preschool children to use this structure. Use in the future can be determined once applicant provides information needed. Resilient material located under other applicable climbing structures in this space is wood chips. Applicant will add more resilient material to the underneath of the swing set. There is a covered sandbox free of hazards. Applicant will have a pitcher of water and cups to allow children access to drinking water outside. Shade for children will be provided by large trees directly covering the designated playground.

The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, Care and Supervision of the Children, Child Discipline Procedures- staff will talk with the children and use redirection, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements. Children will be signed in and out on a paper log by staff for now due to COVID-19, however, requirements for authorized representatives signing children in and out post-pandemic were discussed. Required licensing postings were observed during today's inspection. COVID-19 postings need to be posted. Report continues on the next page.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: PAPERMILL CREEK CHILDREN'S CORNER
FACILITY NUMBER: 214005529
VISIT DATE: 02/12/2021
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The facility will conduct monthly disaster drills and a log will be maintained for review upon request. The fire inspection was conducted, and approval was received on 1/27/21.
This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used.
LPA's also reviewed COVID-19 required postings and provided additional COVID-19 resources to applicants. LPA reviewed the completed COVID-19 self assessment guide with the applicant which was received on 1/12/21. Applicant was informed that access to available Personal Protective Equipment (PPE) may be available through the local child care resource and referral agency.
The following document(s) were given to LPA Schnell during today's inspection:
-Updated LIC 200A, updated Criminal Record Statement signed, health screening for Alisa Lamp.
An electronic copy of this four page report will be emailed to applicant Lourdes Romo on 2/16/21. Applicant was asked to review the report and return a signed copy of the report to LPA Schnell.
LPA Schnell will recommend licensure of this facility for a capacity of 18 children once the following is received:
-Submit Lead Poison Training Certificate and school transcripts to verify education requirement for Alisa as site supervisor of the facility.
-Copy of Personnel Policies with previously identified corrections that were needed
-Garbage cans with tight fitting lids need to be obtained and places in the classroom and on the the playground area.
-Obtain a thermometer and tweezers for the first aid kit.
-Submit a request for a waiver to share the children's bathrooms with other programs operated by the school district on the same campus.
-Send a picture of all COVID-19 postings posted at the facility visible to authorized representatives dropping off/picking up children.
-Add additional resilient material to the underneath of the swing set outside.
-LPA receives a signed copy of this four page pre-licensing report.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4