410500494-4-29-2019-05-CC-AMEN-BBPV8W-20190429161327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500494
Report Date: 04/29/2019
Date Signed: 04/29/2019 04:13:31 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:	PACIFICA PLAYSCHOOL		FACILITY NUMBER:	410500494
ADMINISTRATOR:	WHEELER, SUZANNE		FACILITY TYPE:	850
ADDRESS:	630 HICKEY BLVD		TELEPHONE:	(650) 359-5673
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY:	44	CENSUS: 44	DATE:	04/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Suzanne Wheeler		TIME COMPLETED:	04:15 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 44 children present. Teacher-child ratio is in compliance today. Days and hours of operation: Monday through Friday 7:00AM-6:00PM. Physical plant toured, including the classrooms used for the program. The facility has fully charged fire extinguishers that meets the minimum requirements, smoke detectors, and carbon monoxide (CO) detectors in the facility. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. Separate staff bathroom is 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 are stored inaccessible to children. Variety of age appropriate toys and materials for children is available. Classrooms are set up for child care and furniture and equipment for children is present. Bedding cots are available for napping. Facility provides snacks and lunch. A sample menu is available. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. Outdoor play area inspected for health and safety hazards. The areas around and under high climbing equipment is cushioned with tanbark. Outdoor activity space surfaces are free of hazards and completely fenced. Facility has posted all the required licensing forms in a prominent accessible location. LPA reviewed staff and children's files. In the children’s files, each child had current immunization records and Parent's Rights (LIC995). In the staff files, each had verification of meeting the educational requirements, health screening with TB test, required staff immunizations, and verification of the mandated child abuse reporting training as compliant with AB1207. Director has current Pediatric First Aid and CPR certification (exp. 4/2020). (Continued on next page 809-C)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019

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: PACIFICA PLAYSCHOOL	FACILITY NUMBER: 410500494
	VISIT DATE: 04/29/2019

NARRATIVE

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Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 and volunteers are required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPA advised staff to frequently visit the Department's website at www.ccld.ca.gov for licensing regulations and updates. Facility may email childcareadvocatesprogram@dss.ca.gov to be added to the email distribution list for licensing updates.

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: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019

LIC809 (FAS) - (06/04)

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