410500307-12-19-2019-05-CC-AMEN-BK227G-20191219160844

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500307
Report Date: 12/19/2019
Date Signed: 12/19/2019 04:08:49 PM

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:	HILLSIDE CHRISTIAN ACADEMY (PS)		FACILITY NUMBER:	410500307
ADMINISTRATOR:	CHRISTINA ELLIOT		FACILITY TYPE:	850
ADDRESS:	1415 HILLSIDE BLVD		TELEPHONE:	(650) 588-6860
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	90	CENSUS: 22	DATE:	12/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Christina Elliot		TIME COMPLETED:	04:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Andrea Medlin met with director for this random annual licensing visit. Purpose of visit explained. There are 22 children present. Teacher-child ratio is in compliance. Days and hours of operation: Monday-Friday 7:00AM-6:00PM. Facility is adequately furnished with age appropriate toys, furniture, equipment, first aid supplies, and napping equipment. Cots are available for napping. Physical plant toured to inspect for health and safety hazards. There are fully charged fire extinguishers that meet minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the facility. Children's bathroom inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. Separate staff bathrooms are available. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per staff, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available. Classrooms are set up for child care and furniture and equipment for children is present. Snacks are provided by the facility; parents provide the meals or have the option to purchase hot lunch. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. Outdoor play areas inspected for health and safety hazards. The areas around and under high climbing equipment is cushioned with tanbark. Outdoor activity spaces are enclosed by fences and surfaces are free of hazards. LPA reviewed staff and children files. In the children’s files, each child has a copy of parent's rights and current immunization records. In the staff files, each has verification of meeting the educational requirements, health screening with TB test, the required staff immunization record, and verification of the mandated child abuse reporting training as compliant with AB1207. Staff has current Pediatric First Aid and CPR certification (exp 1/2020) (Continued on next page 809-C)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HILLSIDE CHRISTIAN ACADEMY (PS)	FACILITY NUMBER: 410500307
	VISIT DATE: 12/19/2019

NARRATIVE

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Incidental Medical Services (IMS) policy discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA is 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. Facility informed that effective 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 reviewed with director the Mandated Child Abuse Reporting training as compliant with AB 1207. As of January 1, 2018 all child care staff are required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

This report is reviewed with director and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

LIC809 (FAS) - (06/04)

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