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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505461
Report Date: 06/20/2023
Date Signed: 06/20/2023 12:28:16 PM

Document Has Been Signed on 06/20/2023 12:28 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:POMEROY RECREATION & REHABILITATION CENTERFACILITY NUMBER:
380505461
ADMINISTRATOR:SNYDER, MATHEW, DIRECTORFACILITY TYPE:
840
ADDRESS:207 SKYLINE BLVD.TELEPHONE:
(415) 665-4100
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 111TOTAL ENROLLED CHILDREN: 111CENSUS: 0DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Mathew SnyderTIME COMPLETED:
12:30 PM
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On June 20, 2023, Program Analyst (LPA) Van performed an unannounced mandated annual inspection and met with Director Mathew Snyder. The purpose of the inspection was explained to the Director. This facility is a school-aged after-school program in Pomeroy Recreation & Rehabilitation Center. The Center approved to use rooms A, B, C, D, E, G, H. The days and hours of operation are Monday to Friday, from 2:00 pm to 6:30 pm year-round. No children were present during the inspection. Per Director, the children arrived at 2 pm.

The Director and LPA inspected the facility for potential health and safety hazards. The facility has an electronic sign-in & out app called ProCare. All parents/guardians were provided a unique code when signing in. All classrooms have age-appropriate games, books, and equipment in good repair. Classrooms have acceptable ventilation and ample lighting. LPA observed that each child has cubbies. The facility has a centralized smoke detector, a fully charged fire extinguisher, and carbon monoxide. The facility has no pools, spas, or other bodies of water. All the bathrooms, toilets, and sinks are clean and well-sanitized. All solid waste bins have a suitable tight-fitted lid on top. The facility has multiple water dispensaries readily available for children. The outdoor playground area is in good repair and completely fenced for supervision. The play structure is age-appropriate and in good condition, with tan bark cushioning underneath for any accidental fall.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: POMEROY RECREATION & REHABILITATION CENTER
FACILITY NUMBER: 380505461
VISIT DATE: 06/20/2023
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In today's inspection, LPA reviewed random samples of children's and staff records. Per Director, children were picked up from the school by a school bus and transported to the Center. The teacher will sign in all children, and a head count will be conducted before entering the classroom. All children had a medical assessment, and the required licensing forms were completed. All staff has criminal record clearance. LPA reviewed and discussed with the Director the Center’s required posting. (i.e., License, waivers, Notification of Parent's Rights, and Notification of Personal Rights). The Director stated that Fire and Earthquake drills are done at least once every six months, and the last drills were conducted on 5/18/2023.

The 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. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

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.

LPA reminded the Director 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. LPA observed that the facility has a record of required immunization of all staff.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: POMEROY RECREATION & REHABILITATION CENTER
FACILITY NUMBER: 380505461
VISIT DATE: 06/20/2023
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The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to complete every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

LPA encouraged the Director to visit the CCLD website at www.ccld.ca.gov for licensing regulations and new updates. The Director can also email childcareadvocatesprogram@dss.ca.gov and ask for the updates to be added to the email list.

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.

During the inspection, LPA requested the following document to be sent to the Licensing office by June 30:
1. Designation of Responsibility (LIC 308)
2. Personnel Report (LIC 500)
3. Documentation/Result of the Water Lead Testing.
4. Incidental Medical Services (IMS) Plan
5. Updated Mandated Reporter training & Pediatric First Aid CPR.

No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Director, Mathew Snyder. Today's report, June 20, 2022, and notice of the site visit were provided to the Director. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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