414000489-6-7-2023-05-CC-CQUO-CSKRX9-20230607132422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000489
Report Date: 06/07/2023
Date Signed: 06/07/2023 01:24:40 PM

Document Has Been Signed on 06/07/2023 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	IHSD, INC-SERRAMONTE HEAD START CENTER		FACILITY NUMBER:	414000489
ADMINISTRATOR:	ZOHREH KHOSHENEVISIAN		FACILITY TYPE:	850
ADDRESS:	699 SERRAMONTE BLVD.		TELEPHONE:	(650) 992-6027
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	40	CENSUS: 11	DATE:	06/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Zohreh Khoshenvisian		TIME COMPLETED:	01:35 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 7, 2023 at approximately 10:55am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with site supervisor, Zohreh Khoshenvisian, and explained the purpose of the inspection. Hours of operation are Monday through Friday 8:00am to 4:00pm. Program is licensed to operate in Classroom A, Classroom B, and outdoor area. During LPA's visit, only Classroom B was in operation. LPA only inspected the day care areas that were currently in use. Present during LPA's visit included site supervisor, 4 teaching staff and 11 preschool children. Facility is operating within capacity limits and ratio during LPA's visit. With site supervisor, LPA inspected current day care areas, indoors and outdoors, for health and safety hazards. LPA observed Classroom B to be clean and properly ventilated. Classroom is sectioned into multiple areas that include a dramatic play, science, building and arts and crafts for children. LPA observed each section to be clean, free from any hazards or poisons. Storage for children's belongings are located inside the classroom, labeled with each child's individual name and assigned number. LPA observed poisons, cleaning supplies and other hazardous materials to be stored inaccessible to children, in classroom's high shelves and/or locked behind child safety locked cabinets. Classroom is equipped with multiple first aid kits, multiple fire extinguishers, fire alarm system, fire sprinklers, and a dual smoke and carbon monoxide detectors. Classroom B also includes a bathroom for children's use. Children's bathroom is equipped with a diaper changing table and toilets. Per site supervisor, no children are currently using the diaper changing table. LPA observed bathroom to be in proper working condition, equipped with appropriate toileting equipment. Garbage bins were observed to have tight fitting lids. Sinks children have access to do not provide water that is warmer than 120 degrees Fahrenheit. LPA observed sinks to be equipped with appropriate sanitation products. LPA observed cabinets under children's sinks have child safety locks and did not contain any poisons or hazardous materials. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: IHSD, INC-SERRAMONTE HEAD START CENTER	FACILITY NUMBER: 414000489
	VISIT DATE: 06/07/2023

NARRATIVE

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Program utilizes mats for napping children. Sheets and blankets are appropriately stored in children's individually labeled baskets. Per site supervisor, mats are sanitized weekly or as needed. Sheets and blankets are also laundered weekly or as needed.

Entire outdoor area is entirely enclosed with an at least 4 ft. high fence. Outdoor area is equipped with a variety of outdoor toys and equipment that were in good working condition. There is a play structure that has resilient padding underneath. Staff utilize an emergency red backpack that is brought from indoors to outdoor area. LPA observed emergency backpack to contain emergency supplies and children's emergency information.

Water is made available to children both indoors and outdoors with a refillable pitcher and water cups. Facility completed required lead water testing. Lead levels were found to be normal.

Children are signed in and out of facility by authorized representative's electronic signatures. LPA observed children to be properly signed in on date of LPA's visit. Facility has license documentation and information properly posted and available for review in classroom. Facility maintains a child care roster that was made available for review. Emergency disaster drills are conducted monthly and are properly logged and documented. Last emergency disaster drill was conducted 03/22/2023.

LPA reviewed facility records that included 10 children's records. Children's files have record of emergency identification information on file and required immunizations. LPA also reviewed staff records that included the teaching staff present. All teaching staff on site have current CPR/First Aid certifications and current Mandated Reporter certifications. Staffs' required immunizations were also made available for review.

Site supervisor 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.

Site supervisor 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.
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: IHSD, INC-SERRAMONTE HEAD START CENTER	FACILITY NUMBER: 414000489
	VISIT DATE: 06/07/2023

NARRATIVE

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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.

Site supervisor 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

No deficiencies were issued under CCR, Title 22, Division 12.

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

Exit interview conducted and report was reviewed with site supervisor, Zohreh Khoshenvisian

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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