410503442-4-12-2023-05-CC-CQUO-CQTRY9-20230412132557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410503442
Report Date: 04/12/2023
Date Signed: 04/12/2023 01:26:05 PM

Document Has Been Signed on 04/12/2023 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	VILLAGE NURSERY SCHOOL		FACILITY NUMBER:	410503442
ADMINISTRATOR:	ARIANNA PAUTIN		FACILITY TYPE:	850
ADDRESS:	474 N PARKVIEW AVENUE		TELEPHONE:	(650) 992-4350
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY:	24	CENSUS: 14	DATE:	04/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Arianna Pautin		TIME COMPLETED:	01:40 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	On April 12, 2023 at approximately 11:10am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with director, Arianna Pautin, and explained the purpose of the inspection. Facility is a co-op program that currently operates from Monday to Wednesday 8:30am to 5:30pm, and Thursday to Friday 8:30am to 4:30pm. Present during LPA's visit included 4 staff members (including director), 2 parent volunteers and 14 preschool age children. All staff working with children have fingerprint clearance on file. Facility is operating within capacity limits and ratio during LPA's visit. With director, LPA inspected facility for health and safety hazards. LPA observed classroom to be clean with age appropriate toys and materials. Classroom is appropriately ventilated with proper temperature and ventilation. Storage for children's belongings are located inside the classroom, labeled with each child's individual names and photos. Classroom is separated into multiple sections that include areas for dramatic play, art, quiet time, and motor skill development. LPA observed classroom to have age appropriate furniture and materials that were in good working condition. Electrical outlets in day care areas were appropriately barricaded and made inaccessible with child safety covers. Facility is equipped with a fully charged fire extinguisher, multiple carbon monoxide detectors and a fire system implemented. LPA observed all poisons, cleaning supplies and other hazardous materials to be properly stored in an off limit area, locked behind child safety locked cabinets and/or in classroom's high shelves. Children's families/authorized representatives provide all children with snacks and lunches. Food is prepared in facility kitchen that is made inaccessible and off limits to enrolled children with a child safety gate. LPA observed kitchen to be clean, free of any poisons or chemicals. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: VILLAGE NURSERY SCHOOL	FACILITY NUMBER: 410503442
	VISIT DATE: 04/12/2023

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
26
27
28
29
30
31
32

(Continued, Page 2...)
Bathrooms were observed to be in proper working condition. Bathrooms are equipped with appropriate toileting equipment and sanitation products. Sinks in bathroom do not provide water that is warmer than 120 degrees Farenheit. There is a separate adult restroom that children do not have access to.

LPA observed outdoor area to be fully fenced. Outdoor area is equipped with age appropriate materials and equipment that were in good working condition. Outdoor area is sectioned into three different areas that include an eating area, running area and play ground area. LPA observed play structure in outdoor area to have resilient padding (wood chips) underneath. Play structure poles include soft padding for additional safety. LPA did not observe any loose debris or hazardous materials in outdoor area.

Drinking water is made available to children both indoors and outdoors with children's individual water bottles that can be refilled at facility with filtered water pitchers. Facility has completed required lead water testing that was within the appropriate lead levels.

Children are signed in and out of facility by parents' written signatures. Facility has license documentation and information properly posted and available for review. Emergency drills are conducted at least once every six months and are properly logged. Last emergency disaster drill was conducted 10/15/2022. Facility maintains a child care roster that was made available for review.

LPA reviewed facility records that included 5 random children's records, staff records and parent/volunteer records. All facility records were observed to be complete. Children's files have a record of emergency identification information on file. Parent/volunteer records have health screening documentation as well as proof of required immunizations. Multiple staff members on site have a current CPR certification that is current. Director's CPR certification will expire 03/2024. Director's Mandated Reporter certification will expire 10/2023.

Director was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: VILLAGE NURSERY SCHOOL	FACILITY NUMBER: 410503442
	VISIT DATE: 04/12/2023

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
26
27
28
29
30
31
32

(Continued, Page 3...)
Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information
regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No deficiencies were issued under CCR, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with director, Arianna Pautin.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3