414000830-10-22-2019-05-CC-MROZ-BH7PP2-20191022112848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414000830
Report Date: 10/22/2019
Date Signed: 10/22/2019 11:28:56 AM

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:	OUR LADY OF ANGELS PRESCHOOL		FACILITY NUMBER:	414000830
ADMINISTRATOR:	CUKAR, LYSETTE		FACILITY TYPE:	850
ADDRESS:	1341 CORTEZ AVENUE		TELEPHONE:	(650) 343-3115
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	38	CENSUS: 31	DATE:	10/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Lysette Cukar		TIME COMPLETED:	11:45 AM

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 made an unannounced Annual Random inspection. LPA met with Director Lysette Cukar and explained purpose of inspection. Present at center were the Director, 3 teachers, and 31 children (preschool age). Center is operating within capacity limits and in compliance with staff to child ratio. Hours of operation are Monday to Friday from 8:30am to 3:00pm. LPA toured and inspected center with Director. There are no bodies of water, firearms, or weapons on the premises. There are two classrooms in the center which are in good condition with proper temperature and ventilation and are free of any hazards. Furniture in classrooms are in good repair. Classrooms have age appropriate toys and equipment. There is one bathroom with a toilet and sink in each classroom. 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. The play structure is age appropriate and in good condition with sufficient cushioning underneath. All required postings are posted on the bulletin board by each classroom. Children bring their own lunch. Snacks are provided by the children's parents and a monthly calendar posted indicates which snacks will be served each day. Drinking water is available for children indoor and outdoors. Food preparation area is clean and free of any toxins or contamination. All storage containers for solid waste have a proper lid. All cleaning products, chemicals, and toxins are inaccessible to children. Incidental Medical Services (IMS) was discussed with Director. There is an IMS plan in place but there are no children receiving services during this school year. Last emergency drill was conducted on October 17, 2019. Emergency drills are conducted every month 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 on site. Each classroom has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a first aid kit. There is a working telephone available in the office. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

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: OUR LADY OF ANGELS PRESCHOOL	FACILITY NUMBER: 414000830
	VISIT DATE: 10/22/2019

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(Continued from first page)

Ten children records reviewed were complete. All children have a record of emergency identification information on file. Four staff records reviewed were complete. All staff have a criminal record clearance on file. All staff have current Pediatric First Aid/CPR certificates on file which expire March 2020.

During inspection,
· Director was informed about San Mateo Child Care Center Stakeholder's Meeting on November 1, 2019 and was given a paper invitation to attend meeting.
· Director 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 1597.662.
· Director was reminded about Mandated Reporter Training available on CCLD website. Training must be completed by staff every two years. (Website: www.mandatedreporterca.com).
· Director was reminded about the Provider Information Notices (PINs) on CCLD website.

No deficiencies cited today.

This report was reviewed and discussed with Director Lysette Cukar. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.

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.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

LIC809 (FAS) - (06/04)

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