410518992-12-10-2019-05-CC-MROZ-BJQPSW-20191210103501

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518992
Report Date: 12/10/2019
Date Signed: 12/10/2019 10:35:08 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:	SAN MATEO-FOSTER CITY SCHL DIST - HORRALL SCHOOL		FACILITY NUMBER:	410518992
ADMINISTRATOR:	DULLEA, PATTIE		FACILITY TYPE:	850
ADDRESS:	949 OCEAN VIEW		TELEPHONE:	(650) 312-7550
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	24	CENSUS: 15	DATE:	12/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Karrie Haselton		TIME COMPLETED:	10:50 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 Analyst (LPA) Marie Rodriguez conducted an unannounced Annual Random inspection. LPA met with Lead Teacher Miroslava Salmeron and explained purpose of inspection. Principal Karrie Haselton arrived a short time later. Center is located in Room 1 inside of LEAD Elementary School (formerly known as Horrall Elementary School). Present in center were the Principal, lead teacher, a teacher's assistant, a parent volunteer, and 15 Pre-K children. Hours of operation are Monday to Friday 8:30am to 12:00pm during the school year. LPA toured and inspected Room 1 with the Principal. There are no bodies of water, firearms, or weapons on the premises. Room 1 is in good condition with proper temperature and ventilation and are free of any hazards. Furniture in classroom is in good repair. Classroom has age appropriate toys and equipment. There is one bathroom in the classroom with one sink and toilet. Bathroom appears to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises. The outdoor play area is fenced for supervision with age appropriate toys and equipment in good condition. Play structure is in good repair with sufficient cushioning underneath. All required postings and waiver are posted on the bulletin board of the classroom. Center only provides a morning snack from the school's food service. A menu is posted for the month. Food preparation area is clean and free of any toxins or contamination. Drinking water is available for children indoor and outdoors. All storage containers for solid waste have a proper lid. All cleaning products, chemicals, and toxins are inaccessible to children. Last emergency drill was conducted on November 15, 2019. The next emergency drill will be conducted on December 13, 2019. Emergency drills are conducted on a monthly basis in conjunction with the school's emergency drill schedule and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system, a fully charged fire extinguisher, a smoke and carbon monoxide detector, and a working telephone available on site. Current phone number is (650) 638-2783. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019

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: SAN MATEO-FOSTER CITY SCHL DIST - HORRALL SCHOOL	FACILITY NUMBER: 410518992
	VISIT DATE: 12/10/2019

NARRATIVE

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Five children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff have a criminal record clearance on file through the school district. Staff have current Pediatric First Aid/CPR certificates.

During inspection,

Principal was given information regarding lead.
Principal was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
Principal was reminded about Mandated Reporter Training. Training must be completed by staff every two years. (Website: www.mandatedreporterca.com).
Principal was reminded about the Provider Information Notices (PINs) on CCLD website.

No deficiencies cited today.

This report was reviewed and discussed with Principal Karrie Haselton. A copy of report was provided. Notice of site visit was observed being posted and shall remain posted for 30 days.

For any additional questions, call San Bruno CCLD Office, Monday - Friday, 8am - 5pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

The following forms are to be updated and submitted to CCLD by December 20, 2019:
LIC 308 – Designation of Administrative Responsibility
LIC 500 – Personnel Report
LIC 610 - Emergency Disaster Plan

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019

LIC809 (FAS) - (06/04)

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