410504156-3-28-2023-05-CC-MOLN-CQCUGH-20230328153422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410504156
Report Date: 03/28/2023
Date Signed: 03/28/2023 03:34:32 PM

Document Has Been Signed on 03/28/2023 03:34 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:	SAN CARLOS-BELMONT AFTER SCHOOL; WHITE OAKS		FACILITY NUMBER:	410504156
ADMINISTRATOR:	THOMPSON, ANGELA		FACILITY TYPE:	840
ADDRESS:	1901 WHITE OAK WAY		TELEPHONE:	(650) 591-3515
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY:	90	CENSUS: 82	DATE:	03/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Angela Thompson		TIME COMPLETED:	03:50 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 March 28, 2023 at @ 1:35PM Licensing Program Analyst (LPA) Maria Olguin-Leon met with Director, Angela Thompson for an unannounced annual inspection. Purpose of inspection was explained. Present today, Director, 7 staff and 12 TK/Kindergarteners. At 2:35, school age children arrived for a total of 82 children. Facility is operating within capacity and in compliance with staff child ratio. Facility operates before & after-school program from Monday to Friday 7:30AM to 9:30AM and 12:00PM to 6:00PM. LPA and Director toured the facility for health and safety hazards. Facility operates on the campus of White Oaks School in classroom #9 (Afterschool program building) & Classroom #5 (makerspace building) Both classrooms were clean with proper ventilation. There are plenty of age-appropriate toys/games, books, furniture and learning materials all in good repair. A children’s loft and pool table are also located inside the classroom #9. Classroom #9 is equipped with two working restrooms with no running hot water. All trash containers have tight fitting lids. Facility uses school playground which has a large play structure in good repair. Playground flooring has tanbark for cushioning falls. There is a large blacktop area and grassy area for children to run and play on. No pools or bodies of water were observed. After school program provides an early bird breakfast and snacks for children. Monthly Breakfast & snack schedule is posted on kitchen cabinets. Food is properly stored and labeled in cabinets and refrigerator to avoid contamination. Children bring their own labeled water bottles and disposable cups are also available. Facility has a large water jug for refilling water. There is a fully equipped first aid kit located in kitchenette cabinet. Incidental Medical Services were discussed, currently there are no children with IMS plan. Isolation area for sick children is by staff desk area on sofas. All cleaning products, chemicals, and toxins are inaccessible to children and locked in storage cabinets. LPA reviewed sign in/out sheet. Parents sign children in and out in the morning/afternoon. After school care children are signed in by staff. Classroom is equipped with two smoke alarms, carbon monoxide detector and two fully charged fire extinguisher. Classrooms have telephone landline and cell phones are available Cont. page 2…

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAN CARLOS-BELMONT AFTER SCHOOL; WHITE OAKS	FACILITY NUMBER: 410504156
	VISIT DATE: 03/28/2023

NARRATIVE

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LPA reviewed 5 children’s records and 6 staff record. All the records were complete and up to date. The facility has all necessary paperwork posted, Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Last emergency fire drill was conducted on January 10, 2023 and is documented. Per Director there are no firearms or weapons on site.

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 – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. 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 ADA, Available at: http://www/adagov/childqanda.htm.

Director was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

The Director was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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. LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPA encouraged the Director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Cont. Page 3...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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: SAN CARLOS-BELMONT AFTER SCHOOL; WHITE OAKS	FACILITY NUMBER: 410504156
	VISIT DATE: 03/28/2023

NARRATIVE

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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/process.

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.

No deficiencies were issued today.

Exit interview conducted and report was reviewed with the Director, Angela Thompson.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC809 (FAS) - (06/04)

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