414000455-9-8-2022-05-CC-CQUO-CJ3UQU-20220908154742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000455
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:48:19 PM

Document Has Been Signed on 09/08/2022 03:48 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:	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: 34	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Jessia Lira		TIME COMPLETED:	04:15 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 September 8, 2022 at approximately 1:40pm, Licensing Program Analyst (LPA) Cayrina Quimbo conducted an unannounced, annual inspection. LPA met with lead teacher, Jessica Lira, and explained the purpose of the inspection. At start of LPA's visit, 5 enrolled children were present with 2 staff members. Facility is an after school program that operates from Monday to Friday 12:30pm to 6:00pm. With lead teacher, LPA inspected the day care areas for health and safety hazards. Program operates out of main classroom, quiet classroom, and outdoor area. LPA observed classrooms to be clean and equipped with age appropriate materials with proper temperature and ventilation. Classrooms are equipped with smoke and carbon monoxide detector and fire alarm system for entire building. Program also utilizes emergency backpacks with fully stocked first aid kits that are taken out to the outdoor area. LPA observed toys, classroom materials, and furniture to be age appropriate and in good working condition. Cleaning supplies, poisons and other hazardous materials are stored in classroom's closet that is off limits to enrolled children. Facility is equipped with a separate boys and girls restroom that allows for individual privacy. LPA observed restrooms to be clean and in proper working condition. All food is stored and prepared in facility's kitchen that 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 authorized representatives. Water is accessible, indoors and outdoors, with refillable water stations and/or water pitchers with disposable cups if needed. Storage for children's belongings are located outside the main classroom with children's individual hooks. (Continued on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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: CITY OF SAN MATEO REC. DEPT - BERESFORD KIDS CLUB	FACILITY NUMBER: 414000455
	VISIT DATE: 09/08/2022

NARRATIVE

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Entire outdoor area is fully fenced by an at least 4 ft. high fence. LPA observed outdoor area to be clean, free of any debris or loose articles. Outdoor area is equipped with play structures that have resilient padding underneath. LPA also observed a sandbox that is maintained daily by Parks and Rec maintenance services.

At approximately 3:00pm, additional school age children arrived to program. Present during inspection included 34 enrolled children and 5 staff members (including lead teacher).

Children's authorized representatives are to sign children out with written signatures. Facility has license documentation and information located in main classroom, properly posted and available for review. Program started August 11, 2022. Per lead teacher, emergency disaster drills have not yet been conducted and is scheduled to be completed next month.

LPA reviewed facility records that included 10 children's records which were complete. Children's files have a record of emergency identification information on file. 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.

Lead teacher is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.comn 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: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

Page: 2 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: CITY OF SAN MATEO REC. DEPT - BERESFORD KIDS CLUB	FACILITY NUMBER: 414000455
	VISIT DATE: 09/08/2022

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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

Lead teacher 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.

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

A notice of site visit was given and must remain posted for 30 days. Failure to maintain postings will result in an immediate $100 civil penalty.

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

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

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