<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410505762
Report Date: 08/08/2023
Date Signed: 08/08/2023 04:23:41 PM


Document Has Been Signed on 08/08/2023 04:23 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: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: 16DATE:
08/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Jennifer HillTIME COMPLETED:
04:30 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
On August 8, 2023 at approximately 2:00 PM, Licensing Program Analyst (LPA) Nathan Garcia met with new director, Jennifer Hill for an unannounced annual inspection for the preschool facility. Purpose of the inspection was explained. There were a total of 16 children and 6 staff members present in the facility. The children were observed during nap time. Facility operates day care Monday - Friday, throughout the school year from 7:30-5:00pm.

With Jennifer, LPA inspected day care rooms and the outdoor space. LPA observed facility has multiple smoke detectors and carbon monoxide detectors, multiple fully charged fire extinguisher model 3A40GR located on multiple areas/in each rooms. The facility has a working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards.

There are first aid supplies available in the classrooms and in the nurse's office. All bathrooms are in working condition. Individual items provided by the parents are labeled and stored appropriately. According to Jennifer, the facility serves breakfast, lunch and PM snacks, all catered by Chefables. Per staff, the children are provided through main tap as source of drinking water, refilled as needed. The kids mainly bring their water bottles from home. All food is stored properly to avoid contamination. Food is stored adequately to prevent contamination and properly labeled. There is water available for children in the yard as well as in the classrooms and emergency bags.

***page 2 for continuation***

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
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: INTERCOMMUNAL SURVIVAL SCHOOL
FACILITY NUMBER: 410505762
VISIT DATE: 08/08/2023
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
26
27
28
29
30
31
32
***Page 2 continued***

LPA observed multiple outdoor areas and play structures are free from health and safety hazards. The outdoor area has a large yard with slides, padded floor for the swings, structures and the sandbox. There are a variety of toys and sport equipment available for the children. There are also sheds/bins and storage areas for the toys when they're not being used.

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 child care 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.
LPA has requested the LIC forms and results on file. Staff provided and forwarded LIC forms associated through email.

According to the Jennifer, the facility is using paper for sign in/out. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log and last drill was conducted on June 12 2023. Per Jennifer, drills are done at least every month. The school also rotates them between lock down/fire and earthquake drills. For napping, the children brings blankets from home, which are washed once a week at home.

The LPA reviewed the facility records. LPA reviewed 4 children's files that were present at the time. All required files were available in folders. LPA reviewed 4 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. The facility has a set learning curriculum posted in the classroom.



***Page 3 for continuation***
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
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: INTERCOMMUNAL SURVIVAL SCHOOL
FACILITY NUMBER: 410505762
VISIT DATE: 08/08/2023
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
26
27
28
29
30
31
32
***Page 3 Continuation***
The 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 a Child Care Center.
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.

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.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file.

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

This facility provides Incidental Medical Services – IMS. According to staff, the facility has a nurse on site that takes care of any allergies and storing medications. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 the ADA, available at: http://www.ada.gov/childqanda.htm

Director was advised 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 Title 22 Division 12 of the California Code of Regulations.

Report was reviewed and signed by director Jennifer Hill.

Today’s report, and notice of site visit will be emailed to the director due to printer malfunction and confirmation of receipt is required.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3