410517924-4-25-2023-05-CC-MOLN-CR8W3T-20230425165629

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410517924
Report Date: 04/25/2023
Date Signed: 04/25/2023 04:56:52 PM

Document Has Been Signed on 04/25/2023 04:56 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:	PENINSULA COVENANT CHURCH AFTERCARE		FACILITY NUMBER:	410517924
ADMINISTRATOR:	CARRION, MEGAN		FACILITY TYPE:	840
ADDRESS:	3560 FARM HILL BLVD.		TELEPHONE:	(650) 365-8094
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	140	CENSUS: 56	DATE:	04/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:03 PM
MET WITH:	Dione Mason		TIME COMPLETED:	05:10 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 April 25, 2023, at 2:00 PM Licensing Program Analyst (LPA) Maria Olguin-Leon met with Director Dione Mason for required unannounced annual inspection. Purpose of the inspection was explained. Present for today’s visit were Director, 74 school-age children and 5 staff. Facility is operating within the capacity and in compliance with staff child ratio on this day. Facility operates an after-school program and offers a transportation to school from other sites. Facility runs a summer school program runs from June – August. With director, LPA inspected the after-school care classroom areas. Facility is currently operating the after-school program in rooms # 2, 3, 15, Gym and play yard. Per Director, they have recently added rooms 22C (Fellowship Hall) for homework area, which is used for 1 hr. a day. LPA conducted a case management and inspected room for health and safety hazards. LPA will approve addition to room for after school program. Play yard structure is free of hazards and poles around playground is fitted with cushioned padding. Flooring under play structure is rubber padding to cushion any falls. There is plenty of shaded areas in outdoor play areas. No pools or bodies of waters were observed. Classrooms are equipped with age-appropriate materials, games and furnishings. Classrooms are properly ventilated. All toilets and sinks are in good working condition. There are separate bathroom for boys and girls. Most trash bins have properly fitted lids. Facility has smoke detector, carbon monoxide detectors and fully charged fire extinguishers in each classroom. Facility has drinking water available for children. After school program provides afternoon snacks for children. Snack schedule is available for parent viewing online. Food is properly stored and labeled in cabinets and refrigerator to avoid contamination. There are fully equipped first aid kit located in each classroom. Incidental Medical Services were discussed. Isolation area for sick children will be in office. All cleaning products, chemicals, and toxins are inaccessible to children and locked in storage cabinets. Facility uses Famly for sign in/out of children. Parents sign children out in the afternoon. After school care children are signed in by staff. Working cell phone service and landline are available on site. Cont. page 2...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PENINSULA COVENANT CHURCH AFTERCARE	FACILITY NUMBER: 410517924
	VISIT DATE: 04/25/2023

NARRATIVE

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LPA reviewed 5 random children’s records 3 staff record. Children’s and staff records were missing documentation of required forms, technical assistance was issued. The facility has all necessary paperwork posted, Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Per Director, lead testing has been completed and will submit results. Per Director there are no firearms or weapons on premises.

LPA informs the director 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. 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 ADA, Available at: http://www/adagov/childqanda.htm.

Director was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

The Director was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee 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. LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

cont. page 3...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PENINSULA COVENANT CHURCH AFTERCARE	FACILITY NUMBER: 410517924
	VISIT DATE: 04/25/2023

NARRATIVE

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Dione Mason.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC809 (FAS) - (06/04)

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