410500506-4-25-2023-05-CC-MOLN-CR8SYA-20230425141714

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500506
Report Date: 04/25/2023
Date Signed: 04/25/2023 02:17:32 PM

Document Has Been Signed on 04/25/2023 02:17 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	PENINSULA COVENANT PRESCHOOL		FACILITY NUMBER:	410500506
ADMINISTRATOR:	SARAH SABATO		FACILITY TYPE:	850
ADDRESS:	3560 FARM HILL BLVD		TELEPHONE:	(650) 365-8079
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	55	CENSUS: 15	DATE:	04/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:59 AM
MET WITH:	Dione Mason		TIME COMPLETED:	02:00 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 April 25, 2023 at 11:00 AM Licensing Program Analyst (LPA) Maria Olguin-Leon meet with Director Dione Mason for required unannounced annual inspection. Facility is operating within capacity and in compliance with staff child ratio. Facility operates preschool program from Monday to Friday 8:30AM to 1:30PM. LPA and Director toured the facility for health and safety hazards. Facility operates in the Peninsula Covent Church and is located behind the church in classrooms #1-#6. Currently facility is only using classroom #4 and #5. Facility is clean with proper temperature and ventilation. There are plenty of age-appropriate toys, furniture and learning materials all in good repair. Storage bins are available for children to store personal items and belongings. Facility has a restroom for children which has shared access from both classroom. Bathroom is working toilets and sinks with no running hot water. There is a separate bathroom for staff use. All trash containers in bathroom and in classroom have fitted lids. All cleaning products, chemicals and toxins are stored and locked in cabinet and inaccessible to children. The outdoor area has plenty of play toys and activities. There is a large playground structure cushioned with sand to absorb falls. All equipment is in good condition. Playground area is surrounded with a 5 ft. fence. There are no pools or bodies of water. Per Director, there are no weapons or firearms on the premises. Children bring lunch from are stored in bins. Facility provides snacks. LPA observed kitchen to be clean and food properly stored to prevent contamination. Facility provides drink cups for children to self serve from a lead tested sink. First aid kit is fully stocked with medical supplies. Incidental Medical Services were discussed. LPA observed IMS to be properly stored and inaccessible to children. LPA reminded Director to keep doctor prescription with medication. Sick children are isolated in office away from other children. LPA reviewed sign in/out sheet which is available outside classrooms. LPA reminded Director to have parents sign full legible signatures. Facility is equipped with fully charged fire extinguishers, working carbon monoxide detector and smoke detectors. Facility has a landline phone available on site and cell phones. Cont. Page 2...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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

FACILITY NAME: PENINSULA COVENANT PRESCHOOL	FACILITY NUMBER: 410500506
	VISIT DATE: 04/25/2023

NARRATIVE

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LPA reviewed 5 children’s records 3 staff record. All the children's records and staff were complete. The facility has all necessary paperwork posted, Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Last emergency drill was conducted on March 10,2023. Per owner water lead testing has been completed and will submit results.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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
Facility has IMS policy on file with Regional Office.

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.

Director 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.

Cont. Page 3

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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

FACILITY NAME: PENINSULA COVENANT PRESCHOOL	FACILITY NUMBER: 410500506
	VISIT DATE: 04/25/2023

NARRATIVE

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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 encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No deficiencies were issued today

Exit interview was conducted and report was reviewed with owner, Dione Mason

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC809 (FAS) - (06/04)

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