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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509300
Report Date: 10/17/2019
Date Signed: 10/17/2019 11:17:12 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:PACIFICA NURSERY SCHOOLFACILITY NUMBER:
410509300
ADMINISTRATOR:MILLER, CATHERINEFACILITY TYPE:
850
ADDRESS:548 CARMEL AVENUETELEPHONE:
(650) 355-4465
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY:35CENSUS: 12DATE:
10/17/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Gretchen LoveTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Andrea Medlin met with director for this plan of correction visit established on 9/11/2019. The following previously cited deficiencies are checked today:
  • Health and Safety Code 1596.954 - Carbon monoxide detectors required; inspection. Every licensed child day care center shall have one or more carbon monoxide detectors in the facility. There are two carbon monoxide (CO) detectors present in facility.
  • Health and Safety Code 1596(a)(1) - Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. S2 has the required immunizations on file.
  • Health and Safety Code 1596.8662(3) On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training within the first 90 days of employment. All staff now have verification of the mandated child abuse reporting training.

This report is reviewed with director and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
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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