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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000944
Report Date: 10/11/2023
Date Signed: 10/11/2023 04:32:14 PM

Document Has Been Signed on 10/11/2023 04:32 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:LONE MOUNTAIN CHILDREN'S CENTERFACILITY NUMBER:
384000944
ADMINISTRATOR:GRILLO, JACQUEFACILITY TYPE:
850
ADDRESS:1806 BELLES STREET-SF PRESIDIOTELEPHONE:
(415) 876-0057
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94129
CAPACITY: 72TOTAL ENROLLED CHILDREN: 94CENSUS: 30DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jacque GrilloTIME COMPLETED:
04:00 PM
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On October 11, 2023 at approximately 1:30pm, Licensing Program Analyst (LPA) Ly conducted an Unannounced Required - 1 Year Visit and met with Site Executive Director, Jaque Grillo during the visit. Purpose of the inspection was explained. There were 13 staff including the Executive Director and the Assistant Director caring for 30 children during the visit. Teacher to child ratios were met on this day. The facility has fully charged fire extinguishers smoke detectors and carbon monoxide detector that meet the requirement. The facility uses clip boards for parents to sign their children in and out of the program. The facility's operation hours are from Monday to Friday from 8:00AM to 4:00PM. The first part time program is Tuesday and Thursday 9:00AM to 1:00PM, and another part time program is Monday, Wednesday and Friday 9:00AM to 1:30PM. The hours for Pre-K children are Monday - Friday 8:30 AM to 2:00PM. On Wednesday, after school care is provided to Pre-K program until 4:00pm.

LPA and Executive Director inspected the center for Health and Safety Hazards. There are no pools, spas or other bodies of water on the premises. Adequate first aid supplies are available. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in Executive Director's Office making it inaccessible to children. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. Children bring their own lunches. The center provides snacks to the children. Drinking water is provided indoor and outdoor by water fountain.

LPA and Executive Director also toured the outdoor play area for Health and Safety Hazards. LPA observed outdoor equipment is in good condition, free from loose, sharp or pointed parts. The play structure appears to be age appropriate for children in care. Areas under slides and other climbing equipment is adequately cushioned. Last Emergency Drill was conducted on 09/08/2023 and properly logged.

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Garfield Leung
Winnie Ly
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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: LONE MOUNTAIN CHILDREN'S CENTER
FACILITY NUMBER: 384000944
VISIT DATE: 10/11/2023
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During today's visit, a random sample of children's and staff’s files were reviewed and found to be complete. At least one staff have current Pediatric First Aid and CPR. Facility has posted all the required licensing forms in a prominent visible location

Executive Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISOR'S NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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: LONE MOUNTAIN CHILDREN'S CENTER
FACILITY NUMBER: 384000944
VISIT DATE: 10/11/2023
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Executive Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care 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.

LPA discussed Child Abuse Mandated Training AB1207 with the Executive Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Executive Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.


An Exit Interview was conducted with Executive Director. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and appeal rights were discussed and left with Executive Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISOR'S NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC809 (FAS) - (06/04)
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