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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410503100
Report Date: 06/13/2019
Date Signed: 06/13/2019 12:33:25 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:PHILLIPS BROOKS NURSERY SCHOOLFACILITY NUMBER:
410503100
ADMINISTRATOR:THERIAULT, NICOLEFACILITY TYPE:
850
ADDRESS:2245 AVY AVE.TELEPHONE:
(650) 854-4545
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:45CENSUS: 0DATE:
06/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Site Supervisor, Nicole Theriault and Strategy Adviser, Lisa BusbyTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA), Cindy Interiano conducted an Annual Random inspection and met with Site Supervisor, Nicole Theriault and Strategy Adviser, Lisa Busby. Purpose of the inspection was explained. Purpose was also for an increase of capacity. Fire Inspector also arrived during inspection to conduct Fire Inspection. Program operates M-F, from 8a-3p, with optional aftercare until 5p, following the ‘Independent School’ Calendar (Aug-June). Program operates in the Early Learning Center Building, in Rooms A (aka ‘PreK East’), Room B (aka ‘Preschool’), and Room C (aka ‘PreK West’). Facility is currently closed for the summer break, so no children were present during inspection. LPA inspected indoors and outdoor for Health and Safety Hazards. Classrooms have age appropriate toys and equipment that are in good repair. Cubbies/Bins inside each classroom are used to store children’s belongings. Restroom #1 inside Room A has 3 toilets with an accessible sink with 3 faucets. Restroom #2 with 1 toilet and 1 sink is near the Kitchen. Restrooms are kept clean, in good repair, and maintained with sufficient supplies. Staff restrooms are located in the Main office. Office and Kitchen area are maintained off limit to children, however children 'walk-through' the Kitchen to get to Restroom #2 and the outdoor play area. Napping equipment is properly stored. Program provides daily snacks and children bring their own meals. Facility has a fully supplied Emergency Kit and Emergency supplies, which are maintained inaccessible to children. Medications are kept in an emergency pack in the child’s assigned classroom, as well as in the Main office. Each Classroom is equipped with an industrial fire alarm system with carbon monoxide detector, and a fully charged Fire Extinguisher. Outdoor play area is kept free of debris and hazardous items. Soft cushioning, sand and tanbark are used as floor cushioning. A daily sweep is conducted by staff of the outdoor play area, including sand area, prior to the children going out for outdoor play. All outdoor toys and equipment are age appropriate and in good repair. Drinking water is readily available outdoors and indoors. All mandatory postings are posted in each classroom, near the sign in/out counter.

See Page 2. . .
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: PHILLIPS BROOKS NURSERY SCHOOL
FACILITY NUMBER: 410503100
VISIT DATE: 06/13/2019
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Facility is currently licensed for 45 PreK children. Facility is requesting an increase of capacity to 55 children. There is a total of 4 toilets and 4 sinks for children’s use, allowing a capacity of 60 PreK children. Indoor space was remeasured, totaling 1929.861 square feet, allowing for a capacity of 55 PreK children. The main outdoor playyard was previously measured to total 3529.42 square feet. The additional outdoor space of the ‘upper yard’ and ‘Tanbark’ area, measures out an additional 999.62 square feet. The total outdoor space is of 4529.04 square feet, allowing for a capacity of 60 PreK children. See facility sketch and capacity worksheet.
Facility can be licensed for the requested capacity of 55 PreK children.

During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Site Supervisor was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Site Supervisor was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Site Supervisor was reminded about Mandated Reporter Training available on CCLD website: (www.ccld.ca.gov or www.mandatedreporterca.com)
*Site Supervisor was reminded about the Provider Information Notices (PINs) on CCLD website.

LPA requested an updated:
*LIC 200A
*LIC 500 (personnel Report)

Once Fire Clearance is received, then Facility will be approved to operate for 55 PreSchool age children

***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 were 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: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2