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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000830
Report Date: 08/03/2020
Date Signed: 08/03/2020 12:19:06 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:OUR LADY OF ANGELS PRESCHOOLFACILITY NUMBER:
414000830
ADMINISTRATOR:CUKAR, LYSETTEFACILITY TYPE:
850
ADDRESS:1341 CORTEZ AVENUETELEPHONE:
(650) 343-3115
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:38CENSUS: 0DATE:
08/03/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lysette CukarTIME COMPLETED:
12:30 PM
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Due to the COVID-19 health crisis, and state, local county orders, a tele-inspection was conducted. Licensing Program Analyst (LPA) Van met with the Director, Lysette Cukar, via Facetime at 9:30 am. Currently, there are no children as the center has yet to re-open. Expect re-opening date is September 8, 2020. The purpose of the tele-inspection today is case management to incorporate room #3 into the daycare in conjunction with a Technical Assistance inspection to support the facility operations during this public health crisis.

LPA inspects the current daycare areas and the newly adds room #3 for health and safety hazards. Per Director, room #3 is being added to the facility license temporarily due to COVID-19, to maintaining the six-foot social distancing for the children. Supporting document from Our Lady of Angels School principal allowed the Preschool to use room #3 from August 2020 – June 2021.

LPA observed the new room to be clean, orderly, and has a variety of age-appropriate toys and books for the children. All furniture is in good repair. There are several child-size tables and chairs. For children's belongings, individual cubbies are available for children's use. All the bathrooms, toilets, and sinks are clean and well sanitized. All solid waste bins have a proper tight-fitted lid on top. The facility has water fountains for drinking water available for children. All cleaning supplies are made inaccessible to children.

The Department received the fire clearance approval on July 23, 2020.

As of August 3, 2020, room #3 is now incorporated into the daycare. This report will be sent to the Director via email with a read receipt confirmation in lieu of the Director's signature.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020
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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