410518963-10-3-2019-05-CC-AMEN-BGM27R-20191003170911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518963
Report Date: 10/03/2019
Date Signed: 10/03/2019 05:09:15 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:	CSSF REC DET-MONTE VERDE AFTER SCHOOL REC PROGRAM		FACILITY NUMBER:	410518963
ADMINISTRATOR:	DANELE DIXON		FACILITY TYPE:	840
ADDRESS:	2551 ST. CLOUD DRIVE		TELEPHONE:	(650) 742-0613
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94080
CAPACITY:	200	CENSUS: 143	DATE:	10/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Laura Armanino, Alondra Gomez		TIME COMPLETED:	05:20 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	Licensing Program Analyst (LPA) Andrea Medlin met with staff and recreation and community services supervisor, Laura Armanino, for this random annual licensing visit. There are 143 children present. Facility is licensed to serve school aged children on the Monte Verde Elementary School campus. Days and hours of operation vary based on dismissal times: Monday-Friday 7:30AM-6:00PM.The facility currently operates their program in portables #1, #2, #23 (exploratorium), and multi-use room. There are fire extinguishers, smoke detectors, carbon monoxide (CO) detectors present in each portable. Physical plant toured, including the portables used for the program. There are school aged outdoor play areas. The areas around and under high climbing equipment is cushioned with soft rubber. Outdoor activity space surfaces are free of hazards. Shaded outdoor areas are available. Staff bathrooms are available. No pools, spas, hot tubs, fish ponds, or similar 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 in the portables. Portables are set up for child care, furniture and equipment for children are available as well. Facility provides snacks. First aid supplies are available. Sick children will be separated from the group and wait for parents to pick up. Facility has posted all the required licensing forms in the main portable. LPA reviewed staff and children's files. In the children's files that were reviewed, each child had a complete record maintained. In the staff files reviewed, staff have verification of meeting the educational requirements, a health screening and TB test, the required staff immunizations, and verification of the mandated child abuse reporting training as compliant with AB 1207. All staff have current Pediatric First Aid and CPR training. (See next page for continuation 809-C)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019

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: CSSF REC DET-MONTE VERDE AFTER SCHOOL REC PROGRAM	FACILITY NUMBER: 410518963
	VISIT DATE: 10/03/2019

NARRATIVE

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Incidental Medical Services (IMS) policy discussed. 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 are required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

This report is reviewed with recreation and community services supervisor 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 Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019

LIC809 (FAS) - (06/04)

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