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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001022
Report Date: 10/23/2019
Date Signed: 10/23/2019 02:57:24 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:BELLE AIR PRESCHOOLFACILITY NUMBER:
414001022
ADMINISTRATOR:PAUAHI MCGINNFACILITY TYPE:
850
ADDRESS:450 3RD AVENUETELEPHONE:
(650) 624-3155
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:96CENSUS: 63DATE:
10/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Office Manager, Amparo JimenezTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Cindy Interiano conducted an Annual/Random inspection and met with Office Manager, Amparo Jimenez. Director was attending a meeting. Purpose of the inspection was explained to Office Manager. Facility operates on the Belle Air Elementary School campus. Program operates in 4 classrooms: Room #1, #2, #5, and #6. Program operates M-F 8a-3p, year-round with periodic breaks throughout the year in Rooms #1, #2, and #6. Room #5 operates an AM session from 8a-11a, and PM session from 12-3p, following the school district calendar (Aug-June), with early dismissals on Thursdays. Present during the inspection was 8 staff supervising 63 PreK children. Program is in compliance with Staff-Child ratios. LPA and Office Manager inspected facility indoors and outdoors for Health and Safety Hazards. Classrooms have age appropriate toys and equipment. Cubbies and Bins are used to store children’s belongings. Facility has an approved waiver to share the boys’ and girls’ restroom with the Kindergarteners. Boys’ restroom has 1 toilet, 2 urinals, and 2 sinks. Girls’ restroom has 3 toilets and 2 sinks. Each classroom has an additional sink. Program also has access and exclusive use to an additional restroom on campus. Restrooms are maintained clean, in good repair, and with adequate supplies by School Janitorial staff. Staff use separate restrooms. Program provides daily snacks and lunch for full day programs and daily snacks for the part day programs. Facility has a fully supplied Emergency Kit and Emergency supplies, in each classroom, which are maintained inaccessible to children. Medications are maintained in child’s assigned classroom and is kept with Guardian consent form, Doctor’s prescription, and a log (when administered). Classrooms have an industrial fire alarm system, a carbon monoxide detector, and a fully charged Fire Extinguisher. Last Emergency disaster drill was conducted on 10/17/19 and is properly logged. Discipline policy is mainly redirection. Napping equipment is properly stored in the classroom. Facility has scheduled use of the outdoor play area. An approved waiver is on file and each classroom has scheduled use of the outdoor play area. Outdoor play area is fenced. Tire bark chips are used as floor cushioning underneath the play structures. All outdoor toys and equipment are age appropriate and in good repair. Drinking water is readily available indoors and outdoors. All mandatory postings are posted in each classroom. LPA reviewed sign in/out sheets and are complete and up-to-date. LPA reviewed children’s files and are complete.

See Page 2. . .
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BELLE AIR PRESCHOOL
FACILITY NUMBER: 414001022
VISIT DATE: 10/23/2019
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During inspection, LPA and Office Manager discussed incident which involved a Staff in the Elementary School After-School program. Office Manager states the Staff is no longer employed with the school and never had contact with the Preschool program or children.

Also, during the inspection, LPA and Office Manager discussed the request to share outdoor play area with the Preschool SDC class. Office Manager states their Preschool Program children do not co-mingle with the Special Education Program children. Each classroom has a scheduled time to go outdoors and typically when one class is exiting the outdoor playarea, another class is entering. Each class has their assigned Teachers to properly supervise the children. LPA and Office Manager inspected outdoor play area and there were no Health and Safety issues observed. However, LPA recommended to monitor the level of tire bark chips, which may need to be evenly distributed throughout the playarea periodically, if not replenished.

Also, during the inspection, Office Manager was asked to remind/advise Director regarding:
*Incidental Medical Services (IMS) policy.
*Having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption and maintain information on file.
*Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)
*New Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts.
*Provider Information Notices (PINs) available on CCLD website.

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Ch. 1. ***

>This report and rights to comment and appeal were discussed with Office Manager. This report must be available in the facility for public review. Notice of site inspection was posted.
Any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2