410500322-5-5-2022-05-CC-CQUO-CE5PCE-20220505111147

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500322
Report Date: 05/05/2022
Date Signed: 05/05/2022 11:12:23 AM

Document Has Been Signed on 05/05/2022 11:12 AM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	HOPE LUTHERAN PRESCHOOL		FACILITY NUMBER:	410500322
ADMINISTRATOR:	TRACY SIRI		FACILITY TYPE:	850
ADDRESS:	600 WEST 42ND AVENUE		TELEPHONE:	(650) 345-8438
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	27	CENSUS: 10	DATE:	05/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tracy Siri		TIME COMPLETED:	11:20 AM

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	On May 5, 2022 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with director, Tracy Siri, and explained the purpose of the inspection. Present during inspection included director, 20 preschool age children (2.9 years to 5 years old), and 2 staff members. Facility is operating within capacity and ratio requirements on this date. Facility operates two separate, part time, programs with a morning session (8:45am to 11:45am) and afternoon session (12:30pm to 3:30pm). With director, LPA inspected facility, indoors and outdoors, for health and safety hazards. Program is a single level facility that operates at Hope Lutheran Church. Program operates out of 3 open classrooms with different sections. Sections include a multi-purpose area, arts and crafts area and play area. LPA observed classrooms to be clean, equipped with age appropriate toys, materials and furniture. Storage for children's belongings are located inside the classroom, labeled with each child's individual names. Classrooms are equipped with fully charged fire extinguisher and carbon monoxide detector. Medication is stored appropriately in classroom, inaccessible to enrolled children and maintained with proper documentation. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit area or facility's high shelves. Children's bathrooms are separated by girls and boys restroom. LPA observed bathrooms to be clean and in proper working condition. All sinks accessible to children do not provide water that is warmer than 120 degrees Fahrenheit. Facility currently provides a food service that includes morning snacks and afternoon snacks only. LPA observed food prep area to be clean and orderly. All food is stored and prepared properly to avoid contamination. Water is available to children indoors and outdoors with water pitchers and disposable cups and/or accessible drinking fountain indoors. (Continue on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: HOPE LUTHERAN PRESCHOOL	FACILITY NUMBER: 410500322
	VISIT DATE: 05/05/2022

NARRATIVE

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Outdoor area was observed to be equipped with age appropriate materials that were in good working condition. There is sufficient resilient padding under play structures in outdoor area. Entire outdoor area is enclosed with an at least 4ft high fence.

Children are signed in and out of facility by their authorized representatives' written signatures. LPA observed all children present were properly signed into the program. Facility has license documentation and information properly posted and available for review.

LPA reviewed facility records that included 10 children's records, 3 staff records (whom were present during inspection). LPA observed children's and staff's records to be complete. Multiple staff members present during inspection have valid CPR certificates that will expire 08/2023. Emergency drills are conducted at least once every six months and are properly logged and documented. Last emergency drill was conducted 01/19/2022.

Facility was 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.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completed certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

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/inspection-process.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: HOPE LUTHERAN PRESCHOOL	FACILITY NUMBER: 410500322
	VISIT DATE: 05/05/2022

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This facility provides Incidental Medical Services – IMS. LPA 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

No deficiencies were issued under CCR, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with director, Tracy Siri.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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