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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500408
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:08:58 AM


Document Has Been Signed on 02/08/2023 11:08 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KIRK HOUSE PRESCHOOLFACILITY NUMBER:
410500408
ADMINISTRATOR:CONNELL, KATHYFACILITY TYPE:
850
ADDRESS:1148 JOHNSON STREETTELEPHONE:
(650) 323-8667
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:44CENSUS: 22DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Director, Kathy ConnellTIME COMPLETED:
11:20 AM
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On February 8th, 2023 at approximately 8:50 AM, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, required annual inspection. LPA met with center director, Kathy Connell, and explained the purpose of the inspection. Present in the facility are director with 4 staff and a total of 22 preschool age children. All adults working in the facility are fingerprint cleared and associated. Facility is currently operating within teacher to child ratio on this date.

Program operates in the ‘Preschool’ section of the Menlo Church property. Program is currently operating as a Part Time program, Monday-Friday from 9am-12pm; two sessions, M,W, F with optional aftercare hours until 2pm & T, TH until 1pm. Program operates in three classrooms: Art room, Block Room, and periodic use of the Room 12, near the Hallway. Program also uses the outside play area.

LPA observed each classroom to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located in between the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system throughout the building as well as multiple fully charged, fire extinguishers. Each classroom has a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information. Medication is stored appropriately in the Art Room, inaccessible to enrolled children and maintained with proper documentation.

All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility's high shelves. Facility offers snacks to children, and families bring their own lunch.. Water is available to children indoors and outdoors. Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Play structures have resilient padding. Children are signed in and out of facility by parents' signatures. Facility has license documentation and information properly posted and available for review.

LPA reviewed facility records that included 5 children's records, 5 staff records. LPA observed children's and staff's records to be complete. There is at least one teacher with valid CPR certificate. Last emergency drill was conducted in both sessions on 10/12/2022 (M/W/F) and 10/13/2022 (T/TH). Emergency drills are conducted at least once every month and are properly logged and documented.

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SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KIRK HOUSE PRESCHOOL
FACILITY NUMBER: 410500408
VISIT DATE: 02/08/2023
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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 completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Directors were 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.

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

Based on today's inspection, deficiencies were not observed, according to California Title 22, Health and Safety Code of Regulations.

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



Exit interview conducted and report was reviewed with center director, Kathy Connell.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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