414000350-2-22-2022-05-CC-MROZ-CBVT4H-20220222132357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000350
Report Date: 02/22/2022
Date Signed: 02/22/2022 01:24:10 PM

Document Has Been Signed on 02/22/2022 01:24 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:	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: 14	DATE:	02/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Jon-Paul Barkhurst		TIME COMPLETED:	01:45 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 made an unannounced Annual 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, two teachers, and 14 preschool children. Center is operating within capacity requirements and in compliance with child to staff ratio. Hours of operation are Monday to Friday from 8:00am to 4:00pm. Class is held from 9:00am to 12:45pm and extended care is from 12:45pm to 4:00pm. 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. School provides morning snack 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. (Continued on next page)

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-6880
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022

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: GAZELLE DEVELOPMENTAL SCHOOL	FACILITY NUMBER: 414000350
	VISIT DATE: 02/22/2022

NARRATIVE

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Twenty-two children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff members have a criminal record clearance on file. Site Supervisor's Pediatric First Aid/CPR certificate expires this month but will be taking a recertification class on Saturday, February 8, 2020. One teacher has a Pediatric First Aid/CPR certificate which expires on September 2023. LPA requested a copy of the new certificate to be sent to CCLD office once class has been completed.

Last emergency drill was conducted in October 2021. 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.

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

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.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-6880
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022

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: 02/22/2022

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Facility representative 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.

LPA discussed the safe sleep regulations with facility representative 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 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.

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 conducted and report was reviewed with facility representative Jon-Paul "JP" Barkhurst.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-6880
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022

LIC809 (FAS) - (06/04)

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