414000455-6-3-2024-05-CC-JGIL-D5VV3F-20240603160439

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000455
Report Date: 06/03/2024
Date Signed: 06/03/2024 04:04:47 PM

Document Has Been Signed on 06/03/2024 04:04 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
SAN BRUNO CC RO, 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: 7	DATE:	06/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Jessia Lira		TIME COMPLETED:	04:30 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 June 3rd, 2024 at approximately 1:35 PM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with lead teacher, Jessica Lira, and explained the purpose of the inspection. Present during LPA's visit included 7 enrolled children, lead teacher, and 4 staff members. Facility is an after school program that operates from Monday to Friday 12:30 PM to 6:00 PM. With lead teacher, LPA inspected the day care areas for health and safety hazards. Program operates from a main classroom, and outdoor area. LPA observed classroom to be clean and equipped with age appropriate materials with proper temperature and ventilation. Classroom is equipped with a smoke and carbon monoxide detector and fire alarm system for the entire building. LPA and lead teacher tested Carbon Monoxide detector in main classroom, which was observed to be working. Program utilizes fully stocked emergency backpack/fanny pack first aid kits. These kits are taken out to the outdoor area. LPA observed toys, classroom materials, and furniture to be age appropriate and in working condition. All cleaning supplies, poisons and other hazardous materials are stored in classroom's closet that is off limits to enrolled children. Facility consists of two separate boys and girls restroom. LPA observed restrooms to be clean and in proper working condition. All food is stored and prepared in facility's kitchen. Facility kitchen is off limits to children. LPA observed kitchen to be clean, properly stored, labeled and prepared to avoid any contamination. Individual drinking bottles and lunch are provided by children's families. Afternoon snack is provided by facility. Water is accessible indoors and outdoors, with refillable water stations and water pitchers. Storage for children's belongings are located outside the main classroom with children's individual hooks. Continued on Page 2...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

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
SAN BRUNO CC RO, 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: 06/03/2024

NARRATIVE

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Entire outdoor area is fully fenced and enclosed. LPA observed outdoor area to be clean and contain shaded areas. Outdoor area is equipped with play structures that have padding underneath. LPA observed a sandbox. Per lead teacher the sand box is maintained daily by Parks and Rec maintenance services. At approximately 3:10 PM, additional school age children arrived to program. Present during inspection included 11 enrolled children and 5 staff members (including lead teacher).

Children's authorized representatives are to sign children in and out with written signatures. Facility has license documentation and information located in main classroom, properly posted and available for review.
Per lead teacher facility conducts emergency disaster drills every 3 months. The last drill was conducted on March 22, 2024.

LPA reviewed facility records that included 5 children's records which were complete. Children's files have a record of emergency identification information on file. LPA reviewed staff records which were complete. LPA observed lead teacher's CPR and First Aid to be current and to expire 09/2024.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Facility representative 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 encourages lead teacher to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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/inspection-process

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

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
SAN BRUNO CC RO, 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: 06/03/2024

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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

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 referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility failed to test for lead water before January 1st, 2023. Type B deficiency is being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with lead teacher, Jessica Lira.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/03/2024 04:04 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CITY OF SAN MATEO REC. DEPT - BERESFORD KIDS CLUB	FACILITY NUMBER: 414000455
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in testing for lead water before January 1st, 2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/17/2024
	Plan of Correction
1 2 3 4	Lead teacher plans to sceduale a lead tester to come into facility and test water fixtures. Lead teacher will then submit proof to the department. Lead teacher will also send in required lead testing forms(LIC 9275, LIC 9276, LIC 999/Facility Sketch) to department.

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: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

LIC809 (FAS) - (06/04)

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