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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000489
Report Date: 11/19/2019
Date Signed: 11/19/2019 12:17:43 PM

COMPREHENSIVE INSPECTION
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:IHSD, INC-SERRAMONTE HEAD START CENTERFACILITY NUMBER:
414000489
ADMINISTRATOR:ZOHREH KHOSHENEVISIANFACILITY TYPE:
850
ADDRESS:699 SERRAMONTE BLVD.TELEPHONE:
(650) 992-6027
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:40CENSUS: 33DATE:
11/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Barbara DonleyTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA)Kaur met with director, Zohreh Khoshenevisian, for a random annual inspection. Purpose of the inspection was explained. Present, there are 33 children with 5 teachers, two aids and the director. Facility is operating within the capacity and in compliance with staff child ratio on this day. Facility operate day care from Monday to Friday 08:00AM to 11:30 AM and 12:30 to 04:00 PM.
With director, LPA inspected the day care classrooms and play yard. While inspecting physical plant LPA observed kids were playing in group in room A and room B. Room A has 16 children and room B has 17 children. There are no pools, spas or other bodies of water at the facility. Facility has multiple smoke detectors, carbon monoxide detectors and fully charged fire extinguishers on site. Facility has working telephone at the site. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored in high cabinets and are inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. All toilets, hand washing facilities are in working condition with proper sanitation in place. Facility has drinking water available for children. Facility has first aid supplies available at the multiple location. Per director, facility provides snacks and lunch. All of the unused electrical outlets have child protective covers installed. Play yard is free of hazards and properly fenced. All of the play structures are steady, in good repair and free of any loose parts. There is enough wooden chips under the play structures to prevent any fall injuries.the last fire drill was conducted on 10/04/19.
See next page for continuation .............
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: IHSD, INC-SERRAMONTE HEAD START CENTER
FACILITY NUMBER: 414000489
VISIT DATE: 11/19/2019
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At 10:30AM, LPA met with Barbara Donnelly, She is regional manager of this facility. At 10:35 LPA reviewed the facility records. LPA observed that facility uses electronic sign in/sign out tablet for children. Facility has all of the required documents posted and visible for the public. LPA reviewed 10 random children's and all staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Facility has record of immunization of each child attending child care. LPA observed facility has record of staff’s immunization on file. Multiple staff members have record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers.

LPA review AB 1207 with the director. Director is aware that as of January 1, 2018 all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

LPA discussed the effects of lead exposure with the director and a handout was provided. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
LIC809 (FAS) - (06/04)
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