410503986-2-21-2020-05-CC-AMEN-BLZT83-20200221132939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410503986
Report Date: 02/21/2020
Date Signed: 02/21/2020 01:29:43 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:	TERRA NOVA CHRISTIAN PRESCHOOL		FACILITY NUMBER:	410503986
ADMINISTRATOR:	DANYEL CHEATHON		FACILITY TYPE:	850
ADDRESS:	1125 TERRA NOVA BLVD.		TELEPHONE:	(650) 355-2962
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY:	59	CENSUS:	DATE:	02/21/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Danyel Cheathon		TIME COMPLETED:	01:30 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) Andrea Medlin met with director for this case management visit due to a request to increase preschool capacity to 125 children. Physical plant toured including indoor and outdoor space. Days and hours of operation will be Monday-Friday 6:00AM-6:00PM. Outdoor play area is completely fenced with age appropriate play structures and tanbark as cushioning below climbing structures. Indoor space is measured and inspected for health and safety hazards; space is divided by three separate areas: classrooms #3, #4, and "sea room" (church fellowship hall). For classroom #3, it measures 416 square feet allowing for 11 children; classroom #4, it measures 429 square feet allowing for 12 children; "sea room" (fellowship hall), it measures 3381 square feet minus encumbered space of 336 square feet for a total square footage usage of 3045 square feet allowing for 87 children. Preschool designated outdoor play space measures 5551 square feet allowing for 74 children. There are a total of 6 sinks, 7 toilets, and 2 urinals available for children's use allowing for 120 children. There is a separate staff bathroom available inside church lobby (women's restroom). Isolation area for a sick child will be in the staff office. All children in the isolation area will need to be visually supervised at all times. Fire clearance will be requested for 120 preschool children from North County Fire Department. Facility will request an outdoor rotation waiver exclusively for preschool children due to insufficient space. The maximum capacity facility could be licensed for is 120 children with approved outdoor rotation waiver. Facility is adequately furnished with age appropriate toys, furniture, equipment, and first aid supplies. There are fire extinguishers, smoke detectors, and carbon monoxide (CO) detector present.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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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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: TERRA NOVA CHRISTIAN PRESCHOOL	FACILITY NUMBER: 410503986
	VISIT DATE: 02/21/2020

NARRATIVE

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Pending approval of the following, then licensure will be recommended for an increase in preschool capacity:

North County Fire Department fire clearance approval for 120 preschool aged children.
Approval of outdoor rotation playground waiver for 120 preschool aged children.

Final licensure will be pending Department review and approval.

This report is reviewed with director and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

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