410503217-10-24-2019-05-CC-CINO-BH9RD7-20191024125529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410503217
Report Date: 10/24/2019
Date Signed: 10/24/2019 12:55:34 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:	TRINITY PRESCHOOL		FACILITY NUMBER:	410503217
ADMINISTRATOR:	LANA HARKNESS, ADM.		FACILITY TYPE:	850
ADDRESS:	330 RAVENSWOOD AVE.		TELEPHONE:	(650) 322-2628
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	36	CENSUS: 30	DATE:	10/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Director, Sushma Krishna		TIME COMPLETED:	01:10 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 conducted an Annual/Random inspection and met with Director, Sushma Krishna. Purpose of the inspection was explained to Director. Facility operates on the second floor of the ‘Angus Hall’ on the Trinity Church property. Program operates in 2 classrooms: ‘Laurel’ and ‘Pine’ rooms with an Art Studio connecting the two classrooms. Program operates M-F, 7:30a-6p, following the school district calendar with a summer camp. Present during the inspection is 6 Staff supervising 30 PreK children. Program is in compliance with Staff:Child ratios. LPA and Director inspected facility indoors and outdoors for Health and Safety Hazards. Classrooms have age appropriate toys and equipment. Hooks, Cubbies, and Bins are used to store children’s belongings. Children’s restroom is in between the classrooms and has 4 toilets and 2 sinks. Each classroom has an additional sink. Restrooms are maintained clean, in good repair, and with adequate supplies. Staff use separate restrooms. Program provides daily snacks and children bring their own lunch. Facility has a fully supplied Emergency Kit and Emergency supplies, in each classroom, which are maintained inaccessible to children. Medications are maintained in child’s assigned classroom and is kept with Guardian consent form, Doctor’s prescription, and a log (when administered). Classrooms have an industrial smoke and carbon monoxide detector, a sprinkler system, and a fully charged Fire Extinguisher. Last Emergency disaster drill was conducted on 10/17/19 and is properly logged. Discipline policy is mainly redirection. Napping equipment is properly stored in the classroom. Facility has an approved outdoor play waiver allowing program to share outdoor play area and have scheduled use with a ‘Mom and Baby’ program, which operates on the first level. Outdoor play area is fenced. All outdoor toys and equipment are age appropriate and in good repair. Outdoor play area, including sand area, is kept free of debris and dangerous conditions. Drinking water is readily available indoors and outdoors. All mandatory postings are properly posted. LPA reviewed sign in/out sheets and are complete and up-to-date. LPA reviewed Staff and children’s files and are complete. Staff immunization and Mandated Reporter training certificates on file. 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: 10/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019

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: TRINITY PRESCHOOL	FACILITY NUMBER: 410503217
	VISIT DATE: 10/24/2019

NARRATIVE

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Page 2. . .

During the inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Director was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption and maintain proof in Staff file.
*Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Director was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com)
*Director was advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts.
*Director was reminded about the Provider Information Notices (PINs) on CCLD website.

***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 Director. This report must be available in the facility for public review. Notice of site inspection was posted.
Director 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: 10/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019

LIC809 (FAS) - (06/04)

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