414000669-12-16-2019-05-CC-MROZ-BJWV33-20191216150404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000669
Report Date: 12/16/2019
Date Signed: 12/16/2019 03:04:11 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:	SAN MATEO-FOSTER CITY SCHL DIST - TURNBULL SCH-AGE		FACILITY NUMBER:	414000669
ADMINISTRATOR:	SUMMERS, ELENA		FACILITY TYPE:	840
ADDRESS:	715 INDIAN AVENUE		TELEPHONE:	(650) 312-7766
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	28	CENSUS: 20	DATE:	12/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Karrie Haselton		TIME COMPLETED:	03:20 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 conducted an unannounced Annual Random inspection. LPA met with Principal Karrie Haselton and explained purpose of inspection. School age program is located in rooms T12 and T13 of the Turnbull Child Development Center. Center is located on the same property as College Park Elementary School. Present was only one teacher and no children during initial inspection of classrooms. Later on during the inspection, 20 children arrived and a teacher and teacher's assistant were present in program. Center is operating within capacity requirements and in compliance with child to staff ratio. Hours of operation are Monday to Friday 12:00pm to 5:00pm during school days and 8:30am to 4:30pm during non-school days. LPA toured and inspected Rooms T12 and T13 with Principal. There are no bodies of water, firearms, or weapons on the premises. Classrooms are in good condition with proper temperature and ventilation and are free of any hazards. Furniture in each classroom are in good repair. Each classroom has age appropriate toys and equipment. There are two bathrooms in each classroom with a sink and toilet in each bathroom. There is also an additional sink in each classroom with a water fountain that is available for children's use. Bathrooms appear to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises. The outdoor play area is fenced for supervision with age appropriate toys and equipment in good condition. Play structure is shared with the Preschool program and is in good repair with sufficient cushioning underneath. Napping equipment was in good condition and properly stored. All required postings and waiver are posted on the bulletin board by the door of each classroom. School age program only provides an afternoon snack which is catered through the food service program from College Park Elementary School. A menu is posted for the month. Food preparation area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. Drinking water is available for children indoor and outdoors. 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) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

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: SAN MATEO-FOSTER CITY SCHL DIST - TURNBULL SCH-AGE	FACILITY NUMBER: 414000669
	VISIT DATE: 12/16/2019

NARRATIVE

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(Continued from first page)

Incidental Medical Services (IMS) was discussed. There is an IMS plan in place but there are no children receiving services during this school year. Last emergency drill was conducted today on December 16, 2019. Emergency drills are conducted on a monthly basis in conjunction with the school's emergency drill schedule and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system connected to the school and a fully charged fire extinguisher, a smoke and carbon monoxide detector, and a working telephone available on site in each classroom. Phone number listed on file is current.

Six children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff have a criminal record clearance on file through the school district. Staff have current Pediatric First Aid/CPR certificates and Mandated Reporter training certificates on file.

During inspection,
· Principal was given information regarding Lead Poisoning Facts and the Technical Support Program.
· Principal was reminded, as of September 1, 2016, 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 1597.622.
· Principal was reminded about Mandated Reporter Training. Training must be completed by staff every two years. (Website: www.mandatedreporterca.com).
· Principal was reminded about the Provider Information Notices (PINs) on CCLD website.

No deficiencies cited today.

This report was reviewed and discussed with Principal Karrie Haselton. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.

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

The following forms are to be updated and submitted to CCLD by January 6, 2020:
LIC 308 – Designation of Administrative Responsibility
LIC 500 – Personnel Report

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

LIC809 (FAS) - (06/04)

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