410505762-9-3-2024-05-CC-ZBAK-D8RUUF-20240903155327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410505762
Report Date: 09/03/2024
Date Signed: 09/03/2024 03:53:46 PM

Document Has Been Signed on 09/03/2024 03:53 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	INTERCOMMUNAL SURVIVAL SCHOOL		FACILITY NUMBER:	410505762
ADMINISTRATOR:	HILL, JENNIFER		FACILITY TYPE:	850
ADDRESS:	713 SECOND AVENUE		TELEPHONE:	(650) 347-0463
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	29	CENSUS: 24	DATE:	09/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:51 PM
MET WITH:	Jennifer Hill		TIME COMPLETED:	04:00 PM

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On 9/3/2024 Licensing Program Analyst (LPA) Basak met with the Director, Jennifer Hill for an unannounced annual inspection. The purpose of the inspection was explained, and LPA granted entry. The director, 7 staff and 24 preschool children were present during the LPA visit. LPA observed the facility was operating within capacity and complied with the staff/child ratio. The facility operates the daycare from Monday - Friday 7:00 am to 5:30 pm.

According to the director, the facility is using an electronic sign-in/out app called Pro Care. LPA observed all authorized representatives have signed for the day.

LPA observed the facility has a license, and all other required documents are posted and visible to the public. The facility has a functioning telephone.

LPA inspected 2 preschool classrooms, room one has children from 2 and a half years old to 4 years old and the other room has children between 4-5 years old.

LPA observed facility has smoke detectors and carbon monoxide detectors in each classroom, and 3 fully charged fire extinguishers in size 2A10BC and 3A40C located in the hallway and the kitchen.

LPA verified with the director the facility has an emergency drill log, and the last drill was conducted in July 18, 2024. Per the Director, drills are done every 2 months.

LPA observed all cleaning supplies and other chemicals are stored in a locked cabinet and inaccessible to the children. LPA verified the facility has a fully stocked first aid kit available in the hallway.

See page 2.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Zeynep Basak	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: INTERCOMMUNAL SURVIVAL SCHOOL	FACILITY NUMBER: 410505762
	VISIT DATE: 09/03/2024

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According to the director, there is one child with allergy and 2 children with Asthma. One's allergy is unknown and EpiPen is ready for any emergency occur. The other child has Asthma. LPA checked and observed that the medications were in their original box, updated, included consent forms, and properly stored in a locked container.
LPA observed the facility has age-appropriate furniture, play, and educational materials for children in each classroom. The facility floor and rugs are in good condition and free of any hazards. Per the director, the facility has installed child-safety outlets during the weekend.
LPA observed there were 2 toilets and two sinks in each classroom and the water temperature was proper. LPA observed all bathrooms are sanitary and in working condition. The facility has enough sleep cots/mats for children and each child has individual sheets and blankets. According to the director, the facility provides breakfast, lunch, and p.m. snacks. LPA observed there is water available for children to refill the water bottles in the playground as well as in the classrooms.
LPA observed outdoor play areas and play structures are free from health and safety hazards, with no sharp edges, no broken or cracked parts on the structures and the playground, and no tripping hazard was observed. There are a variety of play and sports equipment available for children in indoor and outdoor playgrounds. There are also sheds/bins and storage areas for the toys when they're not being used.
The LPA reviewed the facility’s records, 5 random children files, and all required papers/forms were available in the children’s folder, including Immunization records, LIC 700. LPA reviewed the 4 qualification requirements of the staff, CPR, and Mandated Reporter Training and, LPA observed the completion certificates on file.
LPA also confirmed staff’s criminal record clearance on the Guardian website during the visit.

The director is aware that all staff is required to complete Mandated Reporter Training every two years. LPA advised the director 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.
See page 3.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Zeynep Basak	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: INTERCOMMUNAL SURVIVAL SCHOOL	FACILITY NUMBER: 410505762
	VISIT DATE: 09/03/2024

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The director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The facility 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5 years after the date of the first test.

For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
The director was advised that for any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, and the report was reviewed with the director, Jennifer Hill.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Zeynep Basak	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC809 (FAS) - (06/04)

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