410517989-6-5-2023-05-CC-MOLN-CSHV46-20230605160548

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410517989
Report Date: 06/05/2023
Date Signed: 06/05/2023 04:05:57 PM

Document Has Been Signed on 06/05/2023 04:05 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:	SEA BREEZE SCHOOL		FACILITY NUMBER:	410517989
ADMINISTRATOR:	WEBER, JERELYN		FACILITY TYPE:	840
ADDRESS:	900 EDGEWATER BLVD.		TELEPHONE:	(650) 574-5437
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY:	105	CENSUS: 12	DATE:	06/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:19 PM
MET WITH:	Jerelyn Weber		TIME 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 June 5, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced annual inspection at Sea Breeze afterschool program. LPA met with Director Jerelyn Weber and purpose of visit was explained. Facility operates five preschool programs on the site of St. Ambrose Church. Present for today’s visit was Director, 4 teachers and 12 school age children. Teacher and children capacity ratio requirements were observed to be in compliance. Preschool programs operate from Monday-Friday from 12:30PM-6:00PM. LPA and Director toured the facility for health and safety hazards. After school program occupy room #3 and room #5. Classrooms are clean with proper ventilation. There are plenty of age-appropriate toys, furniture and learning materials all in good repair. There are children’s restrooms located in each classroom. Restrooms have working toilets and sinks for washing hands and no running hot water. There is a separate bathroom for staff usage on premises. Facility outdoor play area has an age-appropriate toys and play structure and no safety hazards were observed. Play structure is cushioned with blue rubber/foam to cushion fall and sand. There is also an artificial grass area located in the middle of playground. Entire outdoor playground is completely enclosed with a 5 ft. fence. There are no pools, spas, or other similar bodies of water on the premises. Per Director, there are no firearms or weapons on site. The facility provides snacks for children. Snack menus are posted in classroom and changed monthly. LPA observed kitchen is equipped with a sink and refrigerator. Food is properly stored to avoid contamination. Children have their own labeled water bottles to use inside or outside. Facility offers filtered water to refill water bottles. All cleaning supplies and toxins are properly stored in kitchen area and locked in cabinets and inaccessible to children. Kitchen is barricaded with a locked door. 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: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

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: SEA BREEZE SCHOOL	FACILITY NUMBER: 410517989
	VISIT DATE: 06/05/2023

NARRATIVE

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LPA reviewed 5 children’s records and 4 staff records. All children's records were complete with all required documents. Facility has posted the required forms (i.e., License, menus, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law (updated), and Emergency Disaster Plan). Last emergency drill was conducted on 05/10/2023 and is properly documented. No record of water lead testing was available. Type B deficiency was issued today.

Incidental Medical Services were discussed with Director, LPA observed medication lock box used for students with IMS plan, currently no students need IMS services. There are several first aid kits available in the classroom with plenty of medical supplies. Isolation area for sick children is in room 5. All storage containers for solid waste have a proper lid. Facility uses Bright wheel App. For parents to sign children in and out. There is also a hard copy sign in sheet available. Classroom has a fully charged fire extinguisher and dual smoke/carbon monoxide detector. Facility is equipped with landlines in each classroom and walkie/talkie for communication with staff.

Director was reminded that all adults 18 and over living or working in the facility 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.

Director 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.

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: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: SEA BREEZE SCHOOL	FACILITY NUMBER: 410517989
	VISIT DATE: 06/05/2023

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.

The following Type B violations (potential health, safety, or personal rights risk to children in care.) was cited for today’s visit:

1. Health and Safety Code 1597.16(a)(1)- A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

**The department may clear all violations after the review of the facilities’ Plan of Correction**

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 Site Director, Jerelyn Weber.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/05/2023 04:05 PM - It Cannot Be Edited

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: SEA BREEZE SCHOOL	FACILITY NUMBER: 410517989
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above ,which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 07/07/2023
	Plan of Correction
1 2 3 4	Director will provide a complete LEAD water report from an approved vendor by the above due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC809 (FAS) - (06/04)

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