410519011-5-4-2022-05-CC-AMEN-CE4VQJ-20220504163824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410519011
Report Date: 05/04/2022
Date Signed: 05/04/2022 04:38:28 PM

Document Has Been Signed on 05/04/2022 04:38 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CSSF REC DEPT-PONDEROSA AFTER SCHOOL REC PROGRAM		FACILITY NUMBER:	410519011
ADMINISTRATOR:	CRISTINA RODRIGUEZ		FACILITY TYPE:	840
ADDRESS:	295 PONDEROSA ROAD		TELEPHONE:	(650) 873-1096
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	160	CENSUS: 59	DATE:	05/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:08 PM
MET WITH:	Kim Morrison		TIME COMPLETED:	04:55 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 facility representative for this required annual licensing visit. Purpose of visit explained. There are 59 children present. Facility meets teacher-child ratio today. Physical plant toured, including the portables used for the program, and outdoor play areas to inspect for health and safety hazards. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. There are staff bathrooms present. No pools, spas, hot tubs, fish ponds, or 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. If a child is taking medication, it is stored in an inaccessible location to children. Facility provides snacks. First aid supplies are available. Sick children will be separated from the group and wait for parents to pick up. 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 hazard. Facility has posted all the required licensing forms (License, Notification of Parent's Rights, Notification of Personal Rights, Earthquake preparedness checklist, and Emergency Disaster Plan). LPA reviewed staff and children's files. In the files that were reviewed, all children have complete files. In the staff files reviewed, all have complete files. All staff have verification of the mandated child abuse reporter training as compliant with AB1207; all staff have the required staff immunizations: measels (MMR), pertussis (Tdap), and flu shot or opt out notification. (continued on next page 809-C)

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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 DEPT-PONDEROSA AFTER SCHOOL REC PROGRAM	FACILITY NUMBER: 410519011
	VISIT DATE: 05/04/2022

NARRATIVE

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Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

This report is reviewed with facility representative 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: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

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