414001235-6-8-2023-05-CC-MOLN-CS3TZ5-20230522150945

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001235
Report Date: 05/22/2023
Date Signed: 06/08/2023 02:54:33 PM

Document Has Been Signed on 06/08/2023 02:54 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:	NEWTON-BREWER ISLAND ELEMENTRY SCHOOL (SMFCSD)		FACILITY NUMBER:	414001235
ADMINISTRATOR:	SHARON WHITE		FACILITY TYPE:	840
ADDRESS:	1151 POLYNESIA DRIVE		TELEPHONE:	(650) 346-8802
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY:	84	CENSUS: 27	DATE:	05/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Ruby Andrade		TIME COMPLETED:	03:30 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 22, 2023 at 1:30PM Licensing Program Analyst (LPA) Maria Olguin-Leon met with Director, Sharon White & Program Manager, Ruby Andrade for an unannounced annual inspection. Purpose of inspection was explained. Present today: Director, Program Manager, 3 staff and 27 school age children. Facility is operating within capacity and in compliance with staff child ratio. Facility operates an after-school program at Brewer Island Elementary School from Monday, Tuesday, Thursday, Friday from 12:20 PM to 6:00PM. Wednesday 12:00PM to 6:00PM. LPA and Program Manager toured the facility for health and safety hazards. Facility operates on the campus of Brewer Island Elementary School in rooms #1 & #2. There are plenty of age-appropriate toys/games, books, learning materials and furniture all in good repair. Classrooms are clean with proper ventilation. Classrooms each have restrooms available for children to use. Sinks have no running hot water. All trash containers have tight fitting lids. Facility uses school’s outdoor playground which has a two large climbing play structures in good repair and no safety hazards. Playground flooring is cushioned with foam/rubber tiles to cushion falls. There is a large blacktop area and grass area for children use for outdoor time. There are no pools, spas or other bodies of water. After school program provides afternoon snacks for children. Snack schedule is available online for parent viewing. Food is properly stored and labeled in cabinets and refrigerator to avoid contamination. Children bring their own labeled water bottles and are refilled from water fountains. Lead water testing has been conducted and report submitted to regional office. There is a fully equipped first aid kit located in classroom stored in a backpack. Incidental Medical Services were discussed, LPA observed medication to be properly stored and labeled and stored in backpack. Isolation area for sick children will be in unused room. All cleaning products, chemicals, and toxins are inaccessible to children and locked in storage cabinets. Facility uses Bright wheel for sign in/out of children. Parents sign children out in the afternoon. After school care children are signed in by staff. Classrooms are equipped with carbon monoxide detector and fully charged fire extinguisher. LPA observed smoke alarm system which is run through the school. Classrooms are equipped with working landline and cell phone service is available on site. Cont. on page 2…

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

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: NEWTON-BREWER ISLAND ELEMENTRY SCHOOL (SMFCSD)	FACILITY NUMBER: 414001235
	VISIT DATE: 05/22/2023

NARRATIVE

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LPA reviewed 5 children’s records and 4 staff record. All the records were complete and up to date. The facility has all necessary paperwork available in a binder, Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Last emergency drill was conducted on March 24, 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. 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. LPA reviewed AB 1207 with the Licensee.

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...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: NEWTON-BREWER ISLAND ELEMENTRY SCHOOL (SMFCSD)	FACILITY NUMBER: 414001235
	VISIT DATE: 05/22/2023

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.

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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

Exit interview conducted and report was reviewed with the Program Manager, Ruby Andrade.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

LIC809 (FAS) - (06/04)

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