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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500510
Report Date: 12/06/2019
Date Signed: 12/06/2019 11:21:38 AM

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, LTDFACILITY NUMBER:
410500510
ADMINISTRATOR:FAGASAVALI MISA, SITE SUP.FACILITY TYPE:
850
ADDRESS:920 PENINSULA WAYTELEPHONE:
(650) 325-1584
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:40CENSUS: 37DATE:
12/06/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Head Teacher, Megan HartTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA), Cindy Interiano met with Head Teacher, Megan Hart. Site Supervisor was at an off-site training. Purpose of the inspection was explained and was for a Case Management inspection to inspect renovated ‘Nursery Blue.’ Present in the facility are 8 staff supervising 37 PreK children.
‘Nursery Blue’ was temporarily relocated to the campus ‘Gym’ while ‘Nursery Blue’ classroom went through water damage repairs. Repairs have been completed and ‘Nursery Blue’ classroom was reopened on 12/02/19.
‘Nursery Blue’ was inspected for Health and Safety hazards. ‘Nursery Blue’ classroom has age appropriate toys and equipment that are in good repair. Cubbies/Bins are used to store children’s belongings. Restrooms in the classroom has 2 toilets and 2 sinks. Restroom is kept clean, in good repair, and maintained with sufficient supplies. Kitchen area is maintained off limit to children. Classroom has sufficient lighting and ventilation. Classroom has an industrial smoke alarm system, a carbon monoxide detector, and a fully charged fire extinguisher. All postings are properly posted near the main entrance of the classroom. Sign in/out sheets were reviewed and are complete and up to date.
‘Nursery Blue’s’ outdoor play area has also been reopened. No Health and Safety hazards were observed. Outdoor playarea has sufficient age appropriate equipment. 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.
Facility is now approved to use ‘Nursery Blue’ classroom and ‘Nursery Blue’ outdoor playarea.

***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 Head Teacher. This report must be available in the facility for public review. Notice of site inspection was posted. Head Teacher 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 MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
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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