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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274404997
Report Date: 01/26/2023
Date Signed: 01/26/2023 01:24:52 PM


Document Has Been Signed on 01/26/2023 01:24 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:PENINSULA CENTER FOR INFANT & TODDLER DEVELOPMENTFACILITY NUMBER:
274404997
ADMINISTRATOR:SHANNAN WATKINSFACILITY TYPE:
830
ADDRESS:780 ELM AVENUETELEPHONE:
(831) 393-2240
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY:44CENSUS: 18DATE:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Becky BucknerTIME COMPLETED:
01:35 PM
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Licensing Program Analysts (LPAs) Marilou Monico and Fermin Campos-Jaramillo conducted an unannounced Required - 1 Year Inspection. LPAs met with Center Director, Becky Buckner, and explained to her the purpose of today's visit. Facility's License, Notification of Parents’ Rights Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday 07:00 AM to 5:30 PM. The facility serves children ages 0 to 2 years old.

The indoor and outdoor areas were toured. LPAs observed that the facility was operating in compliance with teacher to children ratio requirement. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. LPAs observed diaper changing tables within arm's reach of a sink. Becky stated that the facility has third party cleaning service that comes after daycare hours to clean the facility.

Foods and beverages were kept protected against contamination and spoilage. The center provides breakfast, lunch, and afternoon snacks to children. There is a kitchen at the facility for food preparation. The kitchen is equipped with refrigerator, freezer, dishwasher, stove, oven, and a sink with hot and cold running water. Drinking water is available for the children indoor via pitchers and disposable cups. LPAs observed trash cans with tight fitting lids for the disposal of solid waste. There is a separate trash can with tight fitting cover for the disposal of diapers in each room. Fire extinguisher, working smoke and carbon monoxide detectors were observed. There are nine (9) sinks and two (2) toilets available for the children. There is a separate staff bathroom next to the director's office.

Becky stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via pitchers and disposable cups. The playground is surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by canopy and building overhang. LPAs observed synthetic grass as resilient material under and around the climbing structure. There were no bodies of water observed.

Continuation on next pages:
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PENINSULA CENTER FOR INFANT & TODDLER DEVELOPMENT
FACILITY NUMBER: 274404997
VISIT DATE: 01/26/2023
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LPAs reviewed 10 children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report, Medical Assessment, Immunization, Infant Needs and Services Plan, and TB test.

Nine (9) staff files were reviewed. Staff records reviewed include Criminal Record Statement (LIC 508), Personnel Record, Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza), educational requirements, and required training. LPAs reminded Center Director that the Mandated Reported Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

This facility provides Incidental Medical Services (IMS). LPAs 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

LPAs discussed the safe sleep regulations with Center Director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs informed Center Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Center 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.
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SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PENINSULA CENTER FOR INFANT & TODDLER DEVELOPMENT
FACILITY NUMBER: 274404997
VISIT DATE: 01/26/2023
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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.

The following item must be submitted to Licensing by February 26, 2023:
1) Designation of Facility Responsibility (LIC 308) with licensee representative's original signature.

As a result of this inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with Center Director, Becky Buckner.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
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