410509433-3-3-2020-05-CC-ACON-BMD23X-20200303160305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410509433
Report Date: 03/03/2020
Date Signed: 03/03/2020 04:03:11 PM

COMPREHENSIVE INSPECTION

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:	SAN CARLOS-BELMONT AFTER SCHOOL; ARUNDEL SITE		FACILITY NUMBER:	410509433
ADMINISTRATOR:	BENEDIC, ELIZABETH		FACILITY TYPE:	840
ADDRESS:	200 ARUNDEL ROAD		TELEPHONE:	(650) 593-0707
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY:	110	CENSUS: 74	DATE:	03/03/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Elizabeth Benedict		TIME COMPLETED:	04:20 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 March 3, 2020 at 1:10 PM, Licensing Program Analyst (LPA) April Cowan met with director for an annual inspection. Purpose of the inspection was explained. Present, in the facility are director, 5 staff, and 74 children in care. Facility is operating within the capacity and is in compliance with staff / child ratio on this day. Facility is located on Public School Property and facility operates after school program from Monday to Friday from 7:30 AM to 6:00 PM. Program operates from 2 room: 14A and 22. With director, LPA inspected the after school rooms and play yard. LPA observed facility has smoke detector, carbon monoxide detector, fully charged fire extinguisher and 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 is in good repair and free of any hazards. There are first aid supplies available in the classroom. All hand washing facilities are in working condition. All storage containers for solid waste are in good repair and have proper lids. All food is stored in a properly manner and has lids to avoid contamination. Food preparation area is free of litter. ........ Report continues on next page

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAN CARLOS-BELMONT AFTER SCHOOL; ARUNDEL SITE	FACILITY NUMBER: 410509433
	VISIT DATE: 03/03/2020

NARRATIVE

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Facility has license and all of the other required documents posted and visible for the public. At 2:56 AM, LPA reviewed the facility records. LPA reviewed seven random children's and 3 random staff's files. All Children's files are complete with all required documents. At 3:13, LPA observed that S1 and S3 has expired Mandated Reporter Training Certificates.
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.

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. 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

>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.
>See next page for technical violation.
This report must be available in the facility for public review. Notice of site visit was observed being posted. 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
The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

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