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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517453
Report Date: 09/05/2019
Date Signed: 09/05/2019 12:45:54 PM

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:HOLY FAMILY CHILDREN'S CENTERFACILITY NUMBER:
410517453
ADMINISTRATOR:ROSS, SUEFACILITY TYPE:
850
ADDRESS:1590 S. CABRILLO HIGHWAYTELEPHONE:
(650) 726-9001
CITY:HALF MOON BAYSTATE: CAZIP CODE:
94019
CAPACITY:34CENSUS: 34DATE:
09/05/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sue RossTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with director for this random annual licensing visit. Purpose of visit explained. There are 34 children present during visit. Teacher-child ratio is in compliance. Days and hours of operation: Monday through Friday 7:15AM-6:00PM. Facility operates on the property of Holy Family Episcopal Church. Physical plant toured to inspect for health and safety hazards. There are fully charged fire extinguishers that meet minimum requirements, smoke detectors, and carbon monoxide (CO) detectors in the facility. Children's bathroom inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. There are 3 toilets and 3 sinks for children's use. Separate staff bathrooms are available. No pools, spas, hot tubs, fish ponds, or bodies of water are present. Per staff, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available. Classrooms are set up for child care and furniture and equipment for children is present. Mats are available for napping; parents provide napping supplies and are responsible to wash once a week. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. Outdoor play areas inspected for health and safety hazards. The areas around and under high climbing equipment is cushioned with tanbark. Outdoor activity spaces are enclosed by fences and surfaces are free of hazards. Facility has posted all the required licensing forms in a prominent accessible location. LPA reviewed staff and children's files. In the children’s files, each child had current immunization records and Parent's Rights (LIC995). In the staff files, each had verification of meeting the educational requirements, health screening with TB test; verification of the required staff immunizations. All staff have verification of the mandated child abuse reporting training as compliant with AB1207. Director has current Pediatric First Aid and CPR (exp 6/2020) certification.

(Continued on next page 809-C)
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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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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: HOLY FAMILY CHILDREN'S CENTER
FACILITY NUMBER: 410517453
VISIT DATE: 09/05/2019
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Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA is 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. Facility informed that effective September 1, 2016, a person may not be employed or volunteer at a child care 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. LPA reviewed with director the Mandated Child Abuse Reporting training as compliant with AB 1207. As of January 1, 2018 all child care staff and volunteers are required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

LPA advised staff to frequently visit the Department's website at www.ccld.ca.gov for licensing regulations and updates. Facility may email childcareadvocatesprogram@dss.ca.gov to be added to the email distribution list for licensing updates.

LPA inspected and measured the outside "art studio." Director would like to add this room to increase capacity at this facility. The room is measured and is 162 square feet which would allow for 4 children. LPA discussed options of increasing capacity.

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: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
LIC809 (FAS) - (06/04)
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