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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410505762
Report Date: 01/29/2020
Date Signed: 01/29/2020 11:42:58 AM

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:INTERCOMMUNAL SURVIVAL SCHOOLFACILITY NUMBER:
410505762
ADMINISTRATOR:CAMACHO, MELINDA ANNFACILITY TYPE:
850
ADDRESS:713 SECOND AVENUETELEPHONE:
(650) 347-0463
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:29CENSUS: 23DATE:
01/29/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Melinda CamachoTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced Annual Required inspection. LPA met with staff and explained purpose of inspection. Director Melinda "Mindy" Camacho arrived a short time later. Present in center were the Director, 2 teachers, 1 teacher's aide, and 23 children (preschool age). Center is operating within capacity requirements and in compliance with child to staff ratio. Hours of operation are Monday to Friday from 7:00am to 5:30pm.

LPA inspected center with Director. There are no bodies of water, firearms, or weapons on the premises. The center is in good repair with proper temperature and ventilation and is free of any hazards. All furniture is in good condition. Each room has age appropriate toys and equipment. Napping equipment is in good condition and properly stored when not in use. All cleaning products and toxins are inaccessible to children. Outdoor play area is fenced for supervision. The outdoor toys and equipment are age appropriate and in good condition. Play structures are age appropriate and in good repair. There is adequate cushioning underneath the play structures.

All required postings are properly posted next to the entrance of the center. Menu is posted for the whole month. Center provides breakfast, lunch, and snacks through Chefables that delivers food daily to the center. Kitchen is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. Bathroom on first floor has two toilets and one sink. Bathroom in basement has two toilets and two sinks. Bathroom areas appear to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises.

Eight children records reviewed were complete. All children have a record of emergency identification information on file. Five staff records were reviewed. All staff members have a criminal record clearance on file. The Director and staff have current Pediatric First Aid/CPR certificates which expire November 2021.

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SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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 2
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: INTERCOMMUNAL SURVIVAL SCHOOL
FACILITY NUMBER: 410505762
VISIT DATE: 01/29/2020
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Last emergency drill was conducted in November 2019. Emergency drills are conducted every 1-2 months and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a functional fire alarm system, working fire and carbon monoxide detectors throughout the center, three fully charged fire extinguishers, and a working telephone is available on-site. Phone number listed is current. Incidental Medical Services (IMS) was discussed. Center currently has no children who need services this school year.

During inspection,
  • Director was given information regarding Technical Support Program (TSP), Required Lead Testing for Drinking Water in Child Care Centers, and Lead Poisoning Facts Flyer.
  • Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
  • Director was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available and filed in staff record.
  • Director was reminded about the Provider Information Notices (PINs) on CCLD website.
  • Director was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

No deficiencies cited today.

This report was reviewed and discussed with Director Mindy Camacho. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
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