410500494-5-29-2024-05-CC-JGIL-D5QVA6-20240529161524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500494
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:15:31 PM

Document Has Been Signed on 05/29/2024 04:15 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 CC RO, 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: 40	DATE:	05/29/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:58 PM
MET WITH:	Alyssa Doleschal		TIME COMPLETED:	04:35 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	On May 29, 2024, at approximately 2:00 PM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with lead teacher, Alyssa Doleschal, and explained the purpose of the inspection. Director Suzanne Wheeler arrived at facility at 3:26 PM. Present during LPA's inspection included 40 enrolled children, director, lead teacher, and three additional teachers. All staff members working in facility are fingerprint cleared. Preschool program currently operates Monday through Friday 7:30 AM to 5:30 PM. Program consists of two classrooms, a kitchen(off-limits), children's bathroom, and outdoor play area. At approximately 2:30 PM, LPA, and lead teacher inspected facility, indoors and outdoors, for health and safety hazards. Facility has a working telephone, fully stocked first aid kit, and two fire extinguishers on site in each classroom. Entire facility has a smoke and fire alarm system implemented. LPA observed cleaning solutions, poisons and other chemicals are stored inaccessible to children in main classroom's locked closet. Per lead teacher, facility has two enrolled children with allergies. One Child has an epi-pen and inhaler for a peanut allergy. Epi-pen is located in an inaccessible area to children and kept in original packaging. Storage for children's belongings are located inside each classroom. Storage areas are labeled with each child's individual names. Both classrooms have age-appropriate furniture and materials that are in working condition. Classrooms have proper temperature and is properly ventilated. LPA observed both classrooms have one accessible children's sink. The bathroom is located between both classrooms and also has four additional accessible sinks and four toilets. All accessible sinks are free of poisons or hazardous materials and do not produce hot water. LPA observed bathroom to be clean and in proper working condition. Preschool program provides breakfast, lunch, and snack. Children's items are properly stored in individual cubbies. Drinking water is available to children, indoors and outdoors, with children's individual drinking bottles and accessible water fountains. Continue on Page 2....

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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

FACILITY NAME: PACIFICA PLAYSCHOOL	FACILITY NUMBER: 410500494
	VISIT DATE: 05/29/2024

NARRATIVE

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LPA observed classroom has enough sleeping cots available for all children in care. Facility washes Sheets weekly.

LPA observed outdoor area to have age-appropriate materials that are in good working condition. Tanbark is located under play structure. LPA observed preschool program to use paper sign in/out system. Classroom has license and all other required documents posted and visible for the public. Preschool program conducts drills every 6 months. Last conducted disaster drill was on 04/25/2024.

LPA reviewed 6 children's files and 4 staff files. Children's and staff files were complete with a record of emergency identification information on file. Lead teacher has a valid CPR/First Aid certificate that will expire 02/12/2026. All staff also have proof of required immunization that were made available for review. Mandated Reporter Training Certificates are also on file for each staff.

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

The 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 al files except one(S2). LPAs encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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 PIN 22-02-CCP. 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	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PACIFICA PLAYSCHOOL	FACILITY NUMBER: 410500494
	VISIT DATE: 05/29/2024

NARRATIVE

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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.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

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 lead teacher, Alyssa Doleschal.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC809 (FAS) - (06/04)

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