410518969-9-23-2019-05-CC-GASL-BGAVKR-20190923163046

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518969
Report Date: 09/23/2019
Date Signed: 09/23/2019 04:30:51 PM

COMPREHENSIVE INSPECTION

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:	FOOTSTEPS@CIPRIANI		FACILITY NUMBER:	410518969
ADMINISTRATOR:	MYERS, MITCH		FACILITY TYPE:	840
ADDRESS:	2525 BUENA VISTA AVENUE		TELEPHONE:	(650) 610-0715
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY:	160	CENSUS: 152	DATE:	09/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Mitch Myers		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	An annual comprehensive inspection was conducted today. (Indicate where facility is located- private site, functioning public school site) Analyst inspected the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The following was observed today: Waiver on file for electronic sign in/out was reviewed Current facility director/site supervisor is Mitch Myers Current designated applicant for the license is Karen Foletta-Hass Current rooms used for care are portable rooms 1 and 2, Rooms 18, 19, 20 next to multipurpose room, multipurpose room including stage, Rooms 7,8, 9, 10, 12, 13, 14, 15,16 The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures (smoke and carbon monoxide detectors present and in working order), Medication Policies, Isolation of Sick Children, Food Service, Transportation, Parents Rights, and Reporting Requirements. Bathrooms for school age children are located in portable 1 and 2. There is also a bathroom the is used during the day by the elementary school but can also be used by children in the after school program after school is dismissed. Supervision of school age children using a functioning school site public playground is achieved by continual visual supervision by staff. Children are signed in to the facility by staff and out of the facility by authorized representatives.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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: FOOTSTEPS@CIPRIANI	FACILITY NUMBER: 410518969
	VISIT DATE: 09/23/2019

NARRATIVE

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Posting requirements for site visits were discussed as well as AB 633 requirements. Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov. Staff immunization are on file. Director was reminded 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. Influenza Declarations were also reviewed. Director was advised of the required annual pesticides training. For More information about changes to the Healthy Schools Act, templates, or articles, you can inspect the DPR website at:
https://apps.cdpr.ca.gov/schoolipm/childcare/training/main.cfm . Director was informed about the Provider Information Notices (PINs) on CCLD website. Director was reminded of Mandated Reporter Training available on CCLD website. Training must be renewed every two years.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS. A review of storage of medications, equipment and supplies, and reviewed children, personnel and administrative records.

No deficiencies cited today.

"NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

LIC809 (FAS) - (06/04)

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