414001067-11-15-2019-05-CC-ACON-BHXV76-20191115151037

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001067
Report Date: 11/15/2019
Date Signed: 11/15/2019 03:10:45 PM

COMPREHENSIVE INSPECTION

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:	CITY OF PACIFICA VALLEMAR CHILDREN'S CENTER		FACILITY NUMBER:	414001067
ADMINISTRATOR:	GRETCHEN HAYES		FACILITY TYPE:	840
ADDRESS:	377 REINA DEL MAR		TELEPHONE:	(650) 738-7466
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY:	150	CENSUS: 22	DATE:	11/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:17 PM
MET WITH:	Gretchen Hayes		TIME COMPLETED:	03:40 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 11/15/19 at 2:15 PM, Licensing Program Analyst (LPA) April Cowan met with director, Gretchen Hayes, for a random annual inspection. Purpose of the inspection was explained. Present in the facility are Director, 5 staff, and 22 school-age children. Facility is operating within capacity and in compliance with staff child ratio on this day. Facility operate day care from Monday to Friday from 7:00 - 8:30 AM and 12:00 - 6:00 PM. Day-care rooms are bungalows 1,2,3,4,and 5. With director, LPA inspected the day care room and play yard. LPA observed facility has working smoke detector, carbon monoxide detector, fully charged fire extinguisher and working telephone on site. All cleaning solutions, poisons and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility is floor is in good repair and free of any hazards. There is first aid supplies available in classroom. All hand washing facilities are in working condition with proper sanitation in place. All storage containers for solid waste are in good repair and have proper lids. All food is stored in a proper manner and has lids to avoid contamination. Facility provides 1 snack per day. Play yard is free of hazards. There is sufficient cushion material in the play yard to help absorb the impact of falls. See next page for continuation .........

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

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: CITY OF PACIFICA VALLEMAR CHILDREN'S CENTER	FACILITY NUMBER: 414001067
	VISIT DATE: 11/15/2019

NARRATIVE

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Continuation from previous page .............

At 2:35 PM, LPA reviewed the facility records. LPA observed that facility has sign in/out sheet. Facility performed last emergency drill 10/16/19 and is properly logged. Facility has license and all other required documents posted and visible for the public view (Personal Rights, Parents Rights Poster, Emergency Plan, Menu, Daily Program, and Car Seat Law). LPA reviewed 10 random children's files Children's files are complete with all required documents. 3 staff files were reviewed and are complete. There are menus posted at least one week in advance and are visible to the child's authorized representative.
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 certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.

The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

An exit interview was conducted with Gretchen Hayes, director, including but not limited to Appeal Procedures, Site Visit, and Initial Appeal Rights.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019

LIC809 (FAS) - (06/04)

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