414000251-7-6-2022-05-CC-ACON-CG3NX4-20220706105033

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000251
Report Date: 07/06/2022
Date Signed: 07/06/2022 10:51:03 AM

Document Has Been Signed on 07/06/2022 10:51 AM - 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:	HOLY CROSS PRESCHOOL		FACILITY NUMBER:	414000251
ADMINISTRATOR:	CHRISTINE SHREVE		FACILITY TYPE:	850
ADDRESS:	900 ALAMEDA DE LAS PULGAS		TELEPHONE:	(650) 631-9338
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY:	48	CENSUS: 0	DATE:	07/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Christine Shreve		TIME COMPLETED:	11:10 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	On July 6, 2022 at 8:34 AM, Licensing Program Analyst (LPA) Cowan met with director Christine Shreve for a 1 Year Required Inspection. Purpose of the inspection was explained. Present, in the facility are director only. School is closed for the summer and will resume in September. Facility operates day care Monday to Friday from 08:30 to 01:00 PM. With director, LPA inspected the day care rooms and play yard. LPA observed facility has smoke detector, 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 floor is in good repair and free of any hazards. There are first aid supplies available in the classroom. All bathrooms are in working condition. All storage containers for solid waste fitted lids. Food is stored adequately to prevent contamination. Play yard is free of hazards. There is a sufficient amount of bark rubber matting to help absorb the impact of falls. There is water available on the yard as well as in the classroom. 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: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

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 3

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: HOLY CROSS PRESCHOOL	FACILITY NUMBER: 414000251
	VISIT DATE: 07/06/2022

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
Facility has license and all other required documents posted and visible for the public. Facility’s last emergency drill was conducted 4/21/22 and is properly logged. At 9:31 AM, LPA reviewed the facility records. LPA reviewed 10 random children's files and 6 staff files. Children’s and staff's files are complete with all required Licensing documents.

LPA discussed Children's files and Covid-19 Protocols with site director.

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, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: HOLY CROSS PRESCHOOL	FACILITY NUMBER: 414000251
	VISIT DATE: 07/06/2022

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
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.

>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.

Exit interview conducted and report was reviewed with the director Christine Shreve.

This report must be available in the facility for public review. Notice of site visit shall 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 was reviewed and will be emailed to the director, Christine Shreve at PRESCHOOL@GOHOLYCROSS.ORG by the close of business on 7/6/22. 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: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3