410519028-2-1-2023-05-CC-MROZ-CNMVBK-20230201151739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410519028
Report Date: 02/01/2023
Date Signed: 02/01/2023 03:17:47 PM

Document Has Been Signed on 02/01/2023 03:17 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:	PETITE SORBONNE PRESCHOOL		FACILITY NUMBER:	410519028
ADMINISTRATOR:	PETTY, JUNE M.		FACILITY TYPE:	850
ADDRESS:	319 E. SANTA INEZ AVENUE		TELEPHONE:	(650) 347-8510
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	36	CENSUS: 11	DATE:	02/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	June Petty		TIME COMPLETED:	03:45 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) Marie Rodriguez conducted an unannounced annual inspection. LPA met with Licensee/Director June Petty and explained purpose of inspection. Present at the school were the Licensee, a teacher, and 11 preschool aged children. Center is operating within capacity limits and in compliance with staff to child ratio. Hours of operation are Monday to Friday from 8:00am to 4:30pm. LPA inspected the school with the Licensee. There are no bodies of water, firearms, or weapons on the premises. The school is in good repair with proper temperature and ventilation and is free of any hazards. All furniture is in good condition. Each classroom has age appropriate toys and equipment. All cleaning products and toxins are inaccessible to children. Outdoor play area is fenced for supervision. The outdoor toys and equipment are age appropriate and in good condition. Play structure is age appropriate and in good repair. There is adequate cushioning underneath the play structure. All required postings are properly posted near the entrance of the school. Menu is posted for the whole month. School provides lunch and morning and afternoon snacks. Drinking water is available for children indoors and outdoors. Kitchen is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. Bathroom has three toilets and three sinks. Bathroom appears to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises. Last emergency drill was conducted in January 18, 2023. Emergency drills are conducted at least once every month and are properly logged. Paper sign-in/out sheets are located at the entrance of the school. The school has a complete paper record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system throughout the center. There are a smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone is available on-site.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PETITE SORBONNE PRESCHOOL	FACILITY NUMBER: 410519028
	VISIT DATE: 02/01/2023

NARRATIVE

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LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Licensee June Petty.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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: PETITE SORBONNE PRESCHOOL	FACILITY NUMBER: 410519028
	VISIT DATE: 02/01/2023

NARRATIVE

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Eleven children records reviewed were complete. All children have a record of emergency identification information on file. Two staff records reviewed were complete. All staff have a criminal record clearance on file. Staff have a current pediatric first aid/CPR certificate that expires October 2023.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff. Training can be taken online at www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was 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 was provided: US Department of Justice (US DOJ) 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.

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.

Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

LIC809 (FAS) - (06/04)

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