414001029-5-17-2023-05-CC-MOLN-CRWV5U-20230517160832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001029
Report Date: 05/17/2023
Date Signed: 05/17/2023 04:08:43 PM

Document Has Been Signed on 05/17/2023 04:08 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SAN CARLOS-BELMONT AFTER SCHOOL-HEATHER SITE		FACILITY NUMBER:	414001029
ADMINISTRATOR:	DASKALAKIS, EVE		FACILITY TYPE:	840
ADDRESS:	2757 MELENDY		TELEPHONE:	(650) 591-1997
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY: 105	TOTAL ENROLLED CHILDREN: 89	CENSUS: 72	DATE:	05/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Kenny Meade		TIME COMPLETED:	04:30 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	On May 17, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon met with Director, Kenny Meade, for an unannounced annual inspection. Purpose of inspection was explained. Present today, Director, 6 staff and 72 school age children. Facility is operating within capacity and in compliance with staff child ratio. Facility operates before & after-school program from Monday to Friday 7:30AM to 9:30AM and 1:20PM to 6:00PM. Wednesday 7:30AM to 8:30AM and 12:25PM to 6:00PM. LPA and Director toured the facility for health and safety hazards. Facility operates on the campus of Heather Elementary School in the Afterschool room. Classroom is clean with proper lighting and ventilation. There are plenty of age-appropriate toys/games, books, furniture, beanbags and learning materials all in good repair. A children’s loft and pool table are also located inside the classroom. Classroom is equipped with two working restrooms with no running hot water. All trash containers have tight fitting lids. Facility uses school playground which has a large play structure in good repair, no hazards were observed. Playground flooring has tanbark for cushioning falls. There is a large blacktop area used by the children to play. Grass area is occasionally used by site. No pools or bodies of water were observed. Per Director, lead water testing will be conducted tomorrow 05/18/2023, report will be submitted to regional office, technical violation issued. The after-school program provides an early bird breakfast and snacks for children. Monthly Breakfast & snack schedules are posted on kitchen cabinets. Food is properly stored and labeled in cabinets and refrigerator to avoid contamination. Children bring their own labeled water bottles and disposable cups are also available. Facility has a large water jug for refilling water. There is a fully equipped first aid kit located in kitchenette cabinet. Incidental Medical Services were discussed, LPA observed medication to be properly stored and labeled in upper kitchen cabinet. Isolation area for sick children is on top of loft area or sofa by door. All cleaning products, chemicals, and toxins are inaccessible to children and locked in storage cabinets. LPA reviewed sign in/out sheet. Parents sign children in and out in the morning/afternoon. After school care children are signed in by staff. Classroom is equipped with two smoke alarms, carbon monoxide detector and two fully charged fire extinguisher. Classroom is equipped with a working telephone landline and cell phones are available. Cont. on page 2…

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAN CARLOS-BELMONT AFTER SCHOOL-HEATHER SITE	FACILITY NUMBER: 414001029
	VISIT DATE: 05/17/2023

NARRATIVE

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LPA reviewed 5 children’s records and 5 staff record. All children’s records were complete and up to date. Staff #1 was missing immunization, technical assistance cited. The facility has all necessary paperwork posted, Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Last emergency fire drill was conducted on May 15, 2023, and is documented. Per Director there are no firearms or weapons on site.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA collected a copy of site IMS Plan. For IMS information see Evaluator Manual – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800) 514-0301 (voice)/(800)514-0383(TTY) and link to publication: Commonly Asked Questions about Child Care Centers and ADA, Available at: http://www/adagov/childqanda.htm.

Director was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The Director was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Cont. Page 3...

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAN CARLOS-BELMONT AFTER SCHOOL-HEATHER SITE	FACILITY NUMBER: 414001029
	VISIT DATE: 05/17/2023

NARRATIVE

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LPA encouraged the Director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the Director, Kenny Meade.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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