414000158-3-10-2022-05-CC-ACON-CCDV7S-20220310151136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000158
Report Date: 03/10/2022
Date Signed: 03/10/2022 03:15:23 PM

Document Has Been Signed on 03/10/2022 03:15 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:	HAPPY CAMPERS PRESCHOOL DAYCARE		FACILITY NUMBER:	414000158
ADMINISTRATOR:	AUDRA TSIVIKAS		FACILITY TYPE:	850
ADDRESS:	510 LAUREL STREET		TELEPHONE:	(650) 678-8244
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY:	106	CENSUS: 60	DATE:	03/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Audra Tsivikas		TIME COMPLETED:	01:50 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 March 10, 2022 at 09:45 AM, Licensing Program Analysts (LPAs) Cowan and Leong met with director, Audra Tsivikas, for a 1 Year Required Inspection. Purpose of the inspection was explained. Present in the facility are director, 10 staff, and 60 children in care. Facility is operating within its capacity, and facility is in compliance with staff / child ratio on this day. Facility operates day-care Monday to Friday from 07:00 AM to 06:00 PM. Facility consist of four classrooms: Monarchs, Grasshoppers, Caterpillars, and Fireflies. With director, LPAs inspected the day care rooms and play yard. LPAs observed facility has installed sprinkler system, carbon monoxide detector, fully charged fire extinguisher, and working telephone on site. All cleaning solutions, poisons and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Facility indoor floor is in good repair and free of any hazards. At 10:13 AM, LPAs observed that corners of cubbies in classrooms have sharp edges. This is a potential risk to children in care. Site director has place an order for corner protectors. A technical violation is issued this day. There are first aid supplies available in the classroom. All bathrooms are in working condition. All storage containers for solid waste fitted lids. Children bring food from home, and all food is stored properly to avoid contamination. Facility has a sufficient amount of sleeping matts available. Water bottles and other items provided by the parents are labeled and stored appropriately. There is a sufficient amount of cushion material (artificial grass) in the play yard to help absorb the impact of falls. There is water available on the yard as well as in the classroom. At 10:36 AM, LPAs observed holes in the poured rubber in the play yard. Site director covered holes with temporary rubber mats. Site director has made an appointment for flooring to be re-poured. A technical violation is issued this day. Report continues on next page……….

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 6

Document Has Been Signed on 03/10/2022 03:15 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAPPY CAMPERS PRESCHOOL DAYCARE	FACILITY NUMBER: 414000158
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above in 1 out of 10children's files which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/11/2022
	Plan of Correction
1 2 3 4	Director agrees to begin checking and logging sleeping infants and email LPA a copy ot the logs by 3-11-22.

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: HAPPY CAMPERS PRESCHOOL DAYCARE	FACILITY NUMBER: 414000158
	VISIT DATE: 03/10/2022

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
26
27
28
29
30
31
32

Page 2
LPAs observed that facility is using electronic sign in / out. LPA collected a print-out of sign in/out. Facility has license and all other required documents posted and visible for the public. Facility’s last emergency drill was conducted 3-8-22 and is properly logged. At 10:15 AM, LPA reviewed the facility records. LPA reviewed 10 random children's files. At 12:22, LPA observed that Staff had not documented the 15 minute check for infants. A Type B citation is issued this day. At LPA reviewed 7 random staff's files. All files are complete with required Licensing Documents.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was 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

Director 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.
Report continues on next page………

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: HAPPY CAMPERS PRESCHOOL DAYCARE	FACILITY NUMBER: 414000158
	VISIT DATE: 03/10/2022

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
26
27
28
29
30
31
32

Page 3
LPA discussed the safe sleep regulations with director 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 [facility representative] 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.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

>See next page for deficiencies

Exit interview conducted and report was reviewed with the Site Director Audra Tsivikas

This report must be available in the facility for public review. Notice of site visit is to be posted for 30 days. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

Copy of this report will be emailed to the director,Audra Tsivikas
at AUDRA@HAPPYCAMPERS123.COM by the close of business on 3/10/22. Confirmation of receipt is required. Signed copy of this report will be stored in the facility file.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC809 (FAS) - (06/04)

Page: 6 of 6