410500510-9-9-2019-05-CC-CINO-BFURAA-20190909125050

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500510
Report Date: 09/09/2019
Date Signed: 09/09/2019 12:50:55 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:	PENINSULA SCHOOL, LTD		FACILITY NUMBER:	410500510
ADMINISTRATOR:	FAGASAVALI MISA, SITE SUP.		FACILITY TYPE:	850
ADDRESS:	920 PENINSULA WAY		TELEPHONE:	(650) 325-1584
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	40	CENSUS: 8	DATE:	09/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Site Supervisor, Fagasavali Misa		TIME COMPLETED:	01:05 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), Cindy Interiano met with Site Supervisor, Fagasavali Misa. Purpose of the inspection was explained and was for an Annual/Random inspection. Purpose was also to inspect a temporary classroom. Present in the facility is Site Supervisor and 3 staff, supervising 8 PreK children in ‘Nursery Green’ classroom. Program operates 9a-12:30p, with optional ‘Before care” from 7:30a-9a and ‘After care’ from 12:30p-5:30p, year-round with periodic breaks throughout the year. During inspection, Site Supervisor, Staff and LPA discussed unusual incident which involved the flooding of ‘Nursery Blue’ classroom. The classroom is temporarily out of service and being assessed for damages. ‘Nursery Blue’s’ outdoor play area is also temporarily off limits. ‘Nursery Blue’ classroom has been temporarily relocated to the Campus ‘Gym.’ ‘Nursery Blue’ classroom was inspected for Health and Safety hazards. Based on Facility sketch, ‘Nursery Blue’s Open Play area’ measures 1125 square feet, allowing for a capacity of 32 PreK children. ‘Nursery Blue’ classroom has age appropriate toys and equipment. Classroom has sufficient lighting and ventilation. Cubbies, hooks, and bins are used to store children’s belongings. Classroom has an accessible restroom on the outside part of the ‘Gym’ Building with one toilet and one sink. Classroom also has exclusive access to a children’s restroom in the Main Building, which has one toilet and one sink. Children must be accompanied to the restroom at all times. Classroom has an industrial smoke and carbon monoxide detector. All postings are posted near the main entrance of the classroom, near the sign in/out area. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019

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: PENINSULA SCHOOL, LTD	FACILITY NUMBER: 410500510
	VISIT DATE: 09/09/2019

NARRATIVE

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'Nursery Blue' outdoor playarea is properly ‘fenced in’ and is kept free of debris and dangerous conditions. Based on the Facility sketch, outdoor play area measures 3360 square feet, allowing for 44 PreK children. All outdoor toys and equipment are age appropriate and in good repair. ‘Nursery Blue’ classroom will periodically use ‘Nursery Green’s’ outdoor playarea. Drinking water is readily available indoors and outdoors.

‘Nursery Green’ classroom was also inspected for Health and Safety hazards, indoors and outdoors. No Health and Safety hazards were observed.

Program serves daily snacks and children bring their own meals. Napping equipment is properly stored in ‘Nursery Green’ classroom.
Facility will replenish sand in the sand box and the boat. Facility will also trim some tree branches in the ‘Nursery Green’s’ outdoor play area. Facility will make sure there are no protruding nails in the sand boxes and play structures.
Facility will ensure Preschool children are properly supervised at all times. LPA reminded Director about no co-mingling of the PreK children with the Private School children, unless on special occasions.
Fire Inspector inspected facility on 09/05/19 and granted fire clearance.

Facility is now approved to use ‘Nursery Blue’ classroom (aka Gym).

A follow up inspection is required once ‘Nursery Blue’ classroom and outdoor playarea re-opens.

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Ch. 1. ***

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted. Site Supervisor was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019

LIC809 (FAS) - (06/04)

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