414000455-9-11-2019-05-CC-MROZ-BFWU7P-20190911152015

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000455
Report Date: 09/11/2019
Date Signed: 09/11/2019 03:20:23 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:	CITY OF SAN MATEO REC. DEPT - BERESFORD KIDS CLUB		FACILITY NUMBER:	414000455
ADMINISTRATOR:	CAROLYN SHAVEL		FACILITY TYPE:	840
ADDRESS:	2720 ALAMEDA DE LAS PULGAS		TELEPHONE:	(650) 522-7440
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	42	CENSUS: 36	DATE:	09/11/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Jessica Lira		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 made an unannounced 3 Year Annual Required inspection. LPA met with Site Director Jessica Lira and explained purpose of inspection. Present at the care center were the Site Director, 1 Teacher, 5 Teacher's Aides, and 36 school aged children. Center is operating within capacity requirements and in compliance with child to staff ratio. The care center operates Monday to Friday from 12:35pm to 6:00pm during the school year only. LPA inspected the center with Site Director. 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. Center has age appropriate toys and equipment in the activity room. There are two bathrooms for children's use. The girls bathroom has two toilets and two sinks. The boys bathroom has one toilet, one urinal, and two sinks. Bathrooms appear to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage. A first aid kit and a first aid backpack and fanny packs are available. The outdoor play area is fenced for supervision. The play structures and outdoor equipment are age appropriate and in good condition. Tanbark is used as cushioning underneath the play structures. All required postings are posted on the bulletin board by the entrance to the center. Menu is posted for the month for review. Only snacks are provided to children. On Wednesdays, children have a minimum day at school and bring their own lunches to the center. Children bring their own water bottles and are able to get drinking water at the water fountain in the main lobby. 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, chemicals, and toxins are inaccessible to children. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

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: CITY OF SAN MATEO REC. DEPT - BERESFORD KIDS CLUB	FACILITY NUMBER: 414000455
	VISIT DATE: 09/11/2019

NARRATIVE

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Last emergency drill was conducted on August 30, 2019. Emergency drills are conducted every 2-3 months based on school year scheduling and properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available.

Ten 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. All staff have a current Pediatric First Aid/CPR certificate on file. Mandated Reporter training is conducted for all staff on a fiscal yearly basis prior to the end of the school year.

During inspection,

Site Director was reminded 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 1597.662.
Site Director was reminded about the Provider Information Notices (PINs) on CCLD website.

No deficiencies cited today.

This report was reviewed and discussed with Site Director Jessica Lira. A copy of report was provided. Notice of site visit was observed being posted and shall remain posted for 30 days.

Any additional questions, call CCLD Office, Monday - Friday, 8am - 5pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

LIC809 (FAS) - (06/04)

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