410518747-7-29-2019-05-CC-WLYY-BEJPQU-20190729113143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518747
Report Date: 07/29/2019
Date Signed: 07/29/2019 11:31:51 AM

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:	RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL		FACILITY NUMBER:	410518747
ADMINISTRATOR:	PENA, ROXANA		FACILITY TYPE:	850
ADDRESS:	701 CHARTER ST., PORT. 2,3,& 4		TELEPHONE:	(650) 482-5953
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94063
CAPACITY:	75	CENSUS: 17	DATE:	07/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Site Supervisor, Roxana Pena, and Head Teacher, Alejandra Barraza.		TIME COMPLETED:	11:50 AM

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	Licensing Program Analysts (LPAs), Winnie Ly and Cindy Interiano conducted an Annual/Random inspection and met with Site Supervisor, Roxana Pena, and Head Teacher, Alejandra Barraza. Inspection was also for an increase of capacity. Present during the inspection is 3 staff supervising 17 PreK children in Room #CDC2. Purpose of the inspection was explained to Site Supervisor. Program operates in classrooms #CDC1, #CDC2, and #CDC3 on the Hoover Elementary School campus. Room #CDC1 operates AM session 9a-12p and PM session 1p-4p, M-F, following the School District Calendar (Aug-June); #CDC2 operates 8a-4p, M-F, year-round with periodic breaks throughout the year; #CDC3 operates two sessions: AM session 8a-11a and PM session 12p-3p, following the School District Calendar (Aug-June). LPAs inspected facility indoors and outdoors for Health and Safety Hazards. Classrooms have age appropriate toys and equipment. Cubbies and hooks are used to store children’s belongings. Restrooms are located inside the classroom, each with a boys and girls restroom with 1 sink and 1 toilet each. Restrooms are kept clean, in good repair, and maintained with adequate supplies. Staff restrooms are located in the Elementary School Staff lounge. Program provides Breakfast, Lunch, and PM Snacks and the food is prepared in the school cafeteria and is delivered daily. Facility has a fully supplied Emergency Kit and Emergency supplies, which are maintained inaccessible to children. Classroom has an industrial fire alarm system, a carbon monoxide detector, and a Fire Extinguisher. Last Emergency Disaster drill was conducted on 04/15/19 and is properly logged. Medications are kept in a locked box, with a current doctor’s prescription and an administration log. Discipline policy is mainly redirection. Napping equipment is properly stored. Facility have exclusive use of two outdoor play areas, each with an age appropriate play structure and tanbark cushioning. Outdoor play area is maintained by School District Janitor, however Staff conduct a daily sweep prior to the children going out for outdoor play. Outdoor play areas are maintained free of debris and hazardous items. All outdoor toys and equipment are age appropriate and in good repair. Drinking water is readily available outdoors and indoors. All mandatory postings are posted in the classroom, including menus. Sign in/out sheets were reviewed and are complete. See Page 2....

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019

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: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL	FACILITY NUMBER: 410518747
	VISIT DATE: 07/29/2019

NARRATIVE

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Discussed during the inspection was incident on 11/08/18 in which a child fell in the outdoor play area and received a cut on the forehead. First Aid was immediately administered and Guardians were contacted. Guardian took child to hospital. Child returned to facility. Outdoor play area was inspected and no tripping hazards were observed.

Facility is requesting an increase of capacity to 96 children. Facility is currently licensed for 75 PreK children.
Room #CDC4 was inspected for Health and Safety Hazards. Room #CDC4 measures 1124.834 square feet, allowing for 32 PreK children. Room #CDC4 has two restrooms, each with a toilet and a sink. Maximum capacity in Room #CDC is of 30 children. Maximum capacity of the License can be of 105 Preschool children ages 2-5. Outdoor playarea was previously measured. See facility sketch and capacity worksheet.
Classrooms will have scheduled use of the outdoor space.

Fire Inspector arrived during inspection to conduct Fire Inspection. Fire Inspector requested additional information and once obtained, fire clearance will be granted.

During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Site Supervisor was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Site Supervisor was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Site Supervisor was reminded about Mandated Reporter Training available on CCLD website: (www.ccld.ca.gov or www.mandatedreporterca.com), however facility has an approved alternative Mandated Reporter Training
*Site Supervisor was reminded about the Provider Information Notices (PINs) on CCLD website.

LPAs requested an updated:
*LIC 200A

Once Fire Clearance is received, then Facility will be approved to operate for 105 PreSchool age children

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Ch. 1. ***

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.
Site Supervisor were advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie Ly	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019

LIC809 (FAS) - (06/04)

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