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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000717
Report Date: 08/24/2023
Date Signed: 08/24/2023 12:34:57 PM

Document Has Been Signed on 08/24/2023 12:34 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:IHSD, INC-FAIR OAKS HEAD START CENTERFACILITY NUMBER:
414000717
ADMINISTRATOR:TEKNEJYAN-AVETISYAN, NAIRAFACILITY TYPE:
850
ADDRESS:3502 MIDDLEFIELD ROADTELEPHONE:
(650) 368-1728
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 86TOTAL ENROLLED CHILDREN: 46CENSUS: 37DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Site Supervisor, Britney Hatfield and Family Service Speacilist, Maritiza AlvarezTIME COMPLETED:
12:50 PM
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On August 24th, 2023 at approximately 8:40AM, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, annual, required inspection. LPA met with Site Supervisor, Britney Hatfield and Family Services Specialist, Maritza Alvarez. Present in the facility are Site Supervisor and 7 staff supervising a total of 37 preschool age children. Facility is operating within its capacity and is in compliance with staff/child ratio on this day. All staff present have fingerprint clearance and is associated to the Administrative File (Facility# 41400931).

Facility operates in Rooms #A, #B, and #C.Program operates Monday-Friday from 8am-4pm, following a 10 month program with periodic breaks throughout the year. LPA observed classrooms to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located inside the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system inside the classrooms as well as a fully charged, fire extinguisher. The classrooms has a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information. LPA observed that medication is stored appropriately, inaccessible to enrolled children and maintained with proper documentation.

All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility high shelves. Facility offers breakfast, lunch, and snacks through Chefables. Monthly menu is posted in each classroom. Filtered water is available to children indoors and outdoors. Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Children are signed in and out of facility with parents' signatures electronically. Facility has license documentation and information properly posted and available for review in each classroom.



LPA reviewed facility records that included 5 children's records and 5 staff records. LPA observed children's and staff's records to be complete. At least one staff have an up to date CPR & First Aid certificate. All staff have up to date Mandated Reporter Certificate. Last emergency drill was conducted 08/2023. Emergency drills are conducted at least once every six months and are properly logged and documented.

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Marie Rodriguez
Leslit Tapia-Mandujano
DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2023
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: IHSD, INC-FAIR OAKS HEAD START CENTER
FACILITY NUMBER: 414000717
VISIT DATE: 08/24/2023
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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.

Director 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 observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on today's inspection, deficiencies were not observed, according to California Title 22, Health and Safety Code of Regulations.

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



Exit interview conducted and report was reviewed with Site Supervisor, Britney Hatfield. Due to technical difficulties, report with will be emailed to bhatfield@izziearlyed.org.
SUPERVISOR'S NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC809 (FAS) - (06/04)
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