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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410505683
Report Date: 04/18/2023
Date Signed: 04/18/2023 03:38:42 PM


Document Has Been Signed on 04/18/2023 03:38 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:SMC COMM COLL DIST-MARY META LAZARUS CHILD DEV CTRFACILITY NUMBER:
410505683
ADMINISTRATOR:BARRIENTOS, MAGGIEFACILITY TYPE:
850
ADDRESS:1700 W. HILLSDALE BLVD.TELEPHONE:
(650) 574-6279
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:58CENSUS: 14DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maggie BarrientosTIME COMPLETED:
03:50 PM
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On 4/18/2023 at 12:30PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Maggie Barrientos. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate preschool-age program. Present was the directors and 6 staff supervising 14 children. Children present had been properly signed in. Staff's criminal record clearances are on file. Preschool program utilizes two classrooms and three, shared, Outdoor Play Spaces. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

At 12:40PM., LPA observed the following: Classrooms were clean with age-appropriate playthings available for the children. Ground surfaces were free of any obstructions or potential hazards. Labeled cubbies are available in classroom for children’s belongings. Furniture, supplies, and playthings inspected were free of sharp or pointed parts. Classroom was equipped with child- sized tables and chairs for snack and seated activities. Children’s bathrooms are maintained clean, with fixtures in operating condition. Diaper changing table is available for staff. Per director, facility protocol is to disinfect table after each use. Staff bathroom is located separate. For napping services, mats are stored in each classroom. Mats inspected were made of cleanable material. Per director, napping sheets are washed weekly. Classrooms had acceptable ventilation and lighting. Disinfectants, poisons and cleaning compounds have been stored inaccessible to children. Outlets and trash bins have been covered. Facility has smoke/ carbon monoxide combination detector, functioning, telephone service, and fully charged fire extinguishers: 3A:40BC located in each classroom. First aid kit was reviewed and is fully stocked.

At 1:10PM, LPA inspected the shared outdoor play area on Upper (Area #1, #2) and Lower Levels (Area #3). Outdoor play yard was completely enclosed with playthings in good repair. Play structure on lower yard is anchored, with rubber padding, and tanbark installed for added safety. For water services, bottles are provided outside with refillable pitchers. Accessible shaded rest area is available for children.


(REFER TO 809C FOR CONT.)
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2023
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: SMC COMM COLL DIST-MARY META LAZARUS CHILD DEV CTR
FACILITY NUMBER: 410505683
VISIT DATE: 04/18/2023
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(Page 2)
At 1:40PM LPA reviewed facility records including 5 children’s files and 3 personnel files. Staff’s files contained the: Education Verification; Required Proof of Immunization; 'Mandated Reporter Training' certification (AB1207); and Personnel Record (LIC501).

Children’s files contained the: Consent for Emergency Medical Treatment (LIC627); Immunization Records, Identification and Emergency Information (LIC700); Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

Staff member had their current ‘Cardiopulmonary Resuscitation and First Aid’ certification, which expires on: 7/2023.

Emergency disaster drill are conducted on-site, with the last drill completed on 3/22/2023. LPA reminded director to ensure all drills are logged.

LPA observed required posting in facility lobby, including the: Facility License; Notice of Parent’s Rights (PUB394); Emergency Disaster Plan (LIC610); Lunch Menu (April); and Seat Belt Safety Laws.

LPA inspected kitchen/ food storage area. Food items inspected were current, and correctly stored. Area was maintained clean, free of trash or rubbish. Per director, food services are provided by outside vendor.



LPA reviewed children’s medication during inspection and IMS services.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
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: SMC COMM COLL DIST-MARY META LAZARUS CHILD DEV CTR
FACILITY NUMBER: 410505683
VISIT DATE: 04/18/2023
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(Page 3)
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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations. Exit interview and Report was reviewed with Director, Maggie Barrientos, and signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. 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: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3