414000350-2-6-2020-05-CC-MROZ-BLJS6B-20200206123539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000350
Report Date: 02/06/2020
Date Signed: 02/06/2020 12:35:46 PM

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:	GAZELLE DEVELOPMENTAL SCHOOL		FACILITY NUMBER:	414000350
ADMINISTRATOR:	MASON, GLORIA		FACILITY TYPE:	850
ADDRESS:	770 N. EL CAMINO REAL		TELEPHONE:	(650) 347-8411
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	34	CENSUS: 18	DATE:	02/06/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Jon-Paul Barkhurst		TIME COMPLETED:	12:50 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	Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Annual Required inspection. LPA met with Head Teacher Jon-Paul "JP" Barkhurst and explained purpose of inspection. The center operates on the lower level of St. Joseph Parish Church. Present in center were the Head Teacher, 2 teachers, and 18 preschool children. Center is operating within capacity requirements and in compliance with child to staff ratio. Hours of operation are Monday to Friday from 9:00am to 4:30pm. Class is held from 9:00am to 12:45pm and extended care is from 12:45pm to 4:30pm. LPA inspected center with Head Teacher. There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The center has age appropriate toys and equipment which are in good condition. Outdoor play area is fenced for supervision. Outdoor toys and equipment are age appropriate and in good condition. All required postings are properly posted on the bulletin board next to the sign in/out sheets. Children prepare their snacks as a class each day. Children bring their own lunch. 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. All cleaning products and toxins are inaccessible to children. There are two bathrooms. The women's bathroom is designated as gender neutral with two toilets and two sinks for children to use. A third stall in the bathroom has a lock and is designated for adult use only. A second bathroom is located in the men's bathroom with two toilets and two sinks. Bathroom areas appear to be clean, in good repair, and free of any hazards. Five children records reviewed were complete. All children have a record of emergency identification information on file. Four staff records reviewed were complete. All staff members have a criminal record clearance on file. Staff have recently expired Pediatric First Aid/CPR certificates but staff will be taking a recertification class on Saturday, February 8, 2020. LPA requested a copy of the new certificates to be sent to CCLD office once class has been completed. (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: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

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: GAZELLE DEVELOPMENTAL SCHOOL	FACILITY NUMBER: 414000350
	VISIT DATE: 02/06/2020

NARRATIVE

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(Continued from first page)

Last emergency drill was conducted on July 17, 2019. Emergency drills are conducted at least once every six months and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone is available on-site. Phone number listed is current. Incidental Medical Services (IMS) was discussed. Center currently has one child who needs services this school year.

During inspection,

Head Teacher was given information regarding Technical Support Program (TSP), Required Lead Testing for Drinking Water in Child Care Centers, and Lead Poisoning Facts Flyer.
Head Teacher 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 1597.622.
Head Teacher was advised about Mandated Reporter training. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available and filed in staff record.
Head Teacher was reminded about the Provider Information Notices (PINs) on CCLD website.
Head Teacher was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00am - 5:00pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

No deficiencies cited today.

This report was reviewed and discussed with Head Teacher JP Barkhurst. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

LIC809 (FAS) - (06/04)

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