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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500510
Report Date: 08/20/2020
Date Signed: 08/28/2020 07:54:23 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:BAKSA, KATALINFACILITY TYPE:
850
ADDRESS:920 PENINSULA WAYTELEPHONE:
(650) 325-1584
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:40CENSUS: 0DATE:
08/20/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Site Supervisor, Katalin BaksaTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA), Cindy Interiano conducted a Case Management inspection and met with Site Supervisor, Katalin Baksa via a Tele-inspection. Purpose of the inspection was explained to Site Supervisor. Program operates in the ‘Nursery Green’ Building and the ‘Nursery Blue’ Building on the Peninsula Elementary School campus and is currently licensed for 40 Preschool age children. Facility has requested to add ‘Nursery Purple,’ an additional classroom/Building which was previously a Kindergarten classroom. Director lead LPA on a virtual inspection of the facility indoors and outdoors for Health and Safety hazards. Classroom has age appropriate toys and equipment for children. Classroom is equipped with an industrial fire alarm, a smoke and carbon monoxide detector, and a fire extinguisher. Classroom has 2 children’s restrooms, each with 1 toilet and 1 sink. Restrooms are maintained clean, in good repair, and with adequate supplies. Outdoor play area is completely fenced and is maintained free of debris and dangerous conditions.

Fire clearance was granted on 08/24/2020.

During the tele-inspection, LPA provided Technical Assistance for Covid-19 guidelines, including Social Distancing, proper use of PPE equipment, and cleaning / disinfecting / sanitizing of commonly used areas/items.

Prior to updating license to include ‘Purple Nursery’
> Final review is required from the Department.

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

>This report will be emailed to facility. This report must be available in the facility for public review. Any additional questions to call Office, M-F, 8a-5p, 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: 08/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020
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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