410518963-10-6-2023-05-CC-CQUO-CWCV4V-20231006160659

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518963
Report Date: 10/06/2023
Date Signed: 10/06/2023 04:07:05 PM

Document Has Been Signed on 10/06/2023 04:07 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CSSF REC DET-MONTE VERDE AFTER SCHOOL REC PROGRAM		FACILITY NUMBER:	410518963
ADMINISTRATOR:	ESPINOZA, ELISIA		FACILITY TYPE:	840
ADDRESS:	2551 ST. CLOUD DRIVE		TELEPHONE:	(650) 742-0613
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	200	CENSUS: 135	DATE:	10/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Elisia Espinoza & Kimberly Morrison		TIME COMPLETED:	05:00 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 October 6, 2023 at approximately 2:30pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with site supervisor, Elisia Espinoza and Recreation and Community Services Supervisor, Kimberly Morrison, and explained the purpose of the visit. CSSF program operates at Monte Verde Elementary School and is licensed to operate in Portable Classrooms #1, #2, #23 (Exploratorium) and Multi-Use Room. Present during LPA's visit included 14 staff members, including site supervisor, and 135 school age children. Hours of operation are Monday to Friday school dismissal to 6:00pm. With site supervisor and Recreation and Community Services supervisor, LPA inspected day care areas currently in use. After school program is currently operating Portable Classrooms #1, #2, #23 and Multi-Use Room. Main room currently used for program is Portable classroom #1. LPA observed after school portable areas to be equipped with appropriate furniture and equipment. There are a variety of games, books, and materials that are age appropriate. LPA observed portable classrooms to have fully charged fire extinguishers, smoke/carbon monoxide detectors and smoke alarm system installed and implemented by school district. Smoke/Carbon monoxide detectors in portable classrooms were tested and observed to be working. After school areas are ventilated with appropriate temperature. Children's belongings are placed in their designated classrooms, labeled with children's names. LPA observed poisons, chemicals and cleaning solutions to be placed in classrooms' high shelves, inaccessible to children. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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 CC RO, 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: 10/06/2023

NARRATIVE

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After school program utilizes school district bathrooms. Bathrooms for children allow for individual privacy. LPA observed bathrooms to be in proper working condition, equipped with appropriate sanitation products. Bathrooms have a garbage bin that is disposed of daily by school district janitorial services. Per site supervisor, children are walked to and from the restroom.

Outdoor area was observed to be entirely enclosed and fenced. LPA observed playgrounds to have play structures with resilient padding underneath. Per site supervisor, no additional after school programs operate on site and recreation program has exclusive use of outdoor areas. LPA did not observe any pools, spas or bodies of water on site.

After school program provides afternoon snacks only. Children have access to water indoors and outdoors with children's individual water bottles that can be refilled on site through store bought gallons of water.

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 referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Per documentation provided by Recreation and Community Services Supervisor, after school program tested their water fixtures May, 2023. Per results, lead water results are below the 5.5. ppb threshold.

Children are signed into after school program by staff. Children's authorized representatives sign children out with written signatures. Required licensing documentation is properly posted and available for review in Portable Classroom #1.

LPA reviewed facility records that included 5 random children's files and 5 staff member's files, which were complete. Children's files have record of emergency identification information on file. Staff have required immunizations on file and current Mandated Reporter certifications. Multiple staff members on site have a valid and current CPR/First Aid certification.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC809 (FAS) - (06/04)

Page: 2 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 CC RO, 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: 10/06/2023

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Site supervisor was informed that as of 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.

Site supervisor was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

Facility representative was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Facility was cited a Type B citation for not completing lead testing requirements by due date of January 1, 2023. Appeal Rights were provided. Program completed lead water testing May 2023, resulting in a below 5.5 ppb threshold. Deficiency was cleared during visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Recreation and Community Services Supervisor, Kimberly Morrison.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/06/2023 04:07 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CSSF REC DET-MONTE VERDE AFTER SCHOOL REC PROGRAM	FACILITY NUMBER: 410518963
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2023

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 observation, interview, record review, the licensee did not comply with the section cited above. Water fixtures were tested for lead after due date of January 1, 2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/06/2023
	Plan of Correction
1 2 3 4	Facility completed lead water testing May 2023. Lead testing results show water fixtures to be below the 5.5 ppb threshold. Recreation and Community Services Supervisor will email LPA copies of full report on this 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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC809 (FAS) - (06/04)

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