410518278-5-19-2025-05-CC-KKRN-DFZUYA-20250423155936

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518278
Report Date: 04/23/2025
Date Signed: 05/19/2025 09:17:32 AM

Document Has Been Signed on 05/19/2025 09:17 AM - 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SOUTH HILLSBOROUGH PRESCHOOL		FACILITY NUMBER:	410518278
ADMINISTRATOR/ DIRECTOR:	PRISE, TAMMY		FACILITY TYPE:	850
ADDRESS:	300 EL CERRITO AVE., RM. 3 & 4		TELEPHONE:	(650) 343-3689
CITY:	HILLSBOROUGH	STATE: CA	ZIP CODE:	94010
CAPACITY: 25	TOTAL ENROLLED CHILDREN: 25	CENSUS: 20	DATE:	04/23/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:57 AM
MET WITH:	Tammy Price		TIME VISIT/ INSPECTION COMPLETED:	01:00 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 23, 2025 at approximately 9:00AM, Licensing Program Analysts (LPAs) Katie Krenn and Nathan Garcia arrived at the facility to conduct an unannounced annual visit. They met with the lead teacher Tammy Price and explained the purpose of today's visit. Present at the facility in addition to the lead teacher were two additional teachers and 20 preschool children. The facility is operating within staffing and ratio requirements on this day. Facility operates two sessions. The preschool session is from 8:30AM - 11:30AM and the Prekindergarten session is from 12:30PM - 3:30PM, both programs are Monday - Friday. The program uses one room and has a dedicated outdoor play ground. LPAs reviewed the sign in sheet where parents/guardians sign their children in and out of the facility and found all signatures to be complete. LPAs observed that all required documents, such as the facility license, notification of parents’ rights, personal rights, car seat laws, emergency disaster plan, and daily activities schedule, were displayed and visible to the public. The most recent emergency disaster drill was conducted on March 14, 2025, and the LPAs observed that it was documented. LPAs reviewed the emergency disaster drill log and found drills are conducted monthly throughout the school year. The facility had a complete first aid kit, a smoke detector, a carbon monoxide detector, a charged fire extinguisher, and an emergency disaster kit. LPAs tested the smoke and carbon monoxide detectors, and both were functioning. continued on page 2

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 05/19/2025 09:19 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/24/2025 03:26 PM

Created By: Katie Krenn On 04/23/2025 at 11:22 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SOUTH HILLSBOROUGH PRESCHOOL	FACILITY NUMBER: 410518278
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Deficiency Dismissed

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, LPAs identified that the incorrect live scan form was used for one of the teachers. This resulted in incomplete criminal record clearance. Therefore, licensee did not comply with the section cited above in one out of three persons which poses an immediate health, safety or personal rights risk to persons in care. This is an amended report. The type A violation has been changed to a type B violation.
	POC Due Date: 04/24/2025
	Plan of Correction
1 2 3 4	The teacher without finger print clearance will complete the live scan finger print process and obtain clearance before returning to work.

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.

	Daniel J Oquendo
NAME OF LICENSING PROGRAM MANAGER:

	Katie Krenn
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SOUTH HILLSBOROUGH PRESCHOOL	FACILITY NUMBER: 410518278
	VISIT DATE: 04/23/2025

NARRATIVE

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The LPAs inspected the indoor and outdoor areas for health and safety hazards. The facility was clean, safe, and well-maintained. LPA observed an unlocked cabinet that contained paints. Lead teacher put a child safety lock on it during the visit. All other disinfectants, cleaning solutions, and poisons were securely stored out of children's reach, and all other accessible cabinets and drawers in the classrooms were free of hazardous materials.

LPAs observed that the classroom had age-appropriate toys, furniture, educational materials, and designated storage space for each child. LPAs noticed one electrical outlets that was not fitted with child safety covers to prevent children's access. The bathrooms were clean, fully operational, and equipped with suitable toileting equipment and sanitation products.

The outdoor playground is fully fenced. The play equipment is in good condition and does not have sharp, loose, or pointed parts. The areas around and under climbing equipment, swings, and slides are cushioned with soft flooring. The sandbox is raked every morning. There are no pools, spas, or bodies of water on the property. Two drinking water fountains were available in the classroom.

The morning session does not eat lunch. In the afternoon session children bring lunch from home. The preschool provides an AM snack to the morning session and a PM snack to the afternoon session. The preschool is a part day program for children 2.5 to 5 years of age, so there is no napping during the school day.

LPAs reviewed the files of five children, confirming that their emergency contact and medical information were complete and in order.

LPAs reviewed three staff files and confirmed that all necessary forms were complete and in order. LPA verified that two of the three staff members held current Pediatric First Aid and CPR certifications. During a review of the staff transcripts, LPAs found that all three staff members had successfully completed twelve units in Early Childhood Education (ECE), which qualifies them to serve as teachers. One of the teachers that works part-time was not fingerprint cleared and associated with the facility. All staff had completed Mandated Reporter Training within the last year.
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NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SOUTH HILLSBOROUGH PRESCHOOL	FACILITY NUMBER: 410518278
	VISIT DATE: 04/23/2025

NARRATIVE

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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. CCC completed testing and was found to exceed the limit in one faucet, which they do not use for drinking. The facility plans to replace and retest the affected fixture C.

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/‌inspection-process.

The director was reminded that all adults 18 and over, 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 Child Care Center. 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.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the lead teacher, Tammy Price.

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC809 (FAS) - (06/04)

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