414001376-5-30-2023-05-CC-AMEN-CSBPW5-20230530114011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001376
Report Date: 05/30/2023
Date Signed: 05/30/2023 11:40:15 AM

Document Has Been Signed on 05/30/2023 11:40 AM - 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:	SSFUSD MARTIN CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	414001376
ADMINISTRATOR:	NICOLE FISHER		FACILITY TYPE:	850
ADDRESS:	35 SCHOOL STREET		TELEPHONE:	(650) 827-2812
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	23	CENSUS:	DATE:	05/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Lisa Ferrari		TIME COMPLETED:	11:45 AM

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	Licensing Program Analyst (LPA) Andrea Medlin met with director for this required annual licensing visit today. Purpose of visit explained. Facility operates as a State preschool subject to Title 5 regulations with regard to teacher-child ratios. Facility meets teacher-child ratio today. Facility operates in classroom #13 on the campus of Martin Elementary School. Facility operates two sessions: 8:30AM-11:30AM and 12:00PM-3:00PM. Physical plant toured to inspect for health and safety hazards. There is a fully charged fire extinguisher that meet minimum requirements, smoke detector, and a carbon monoxide (CO) detector in the facility. Children's bathroom inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. A separate staff bathroom is available. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per director, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available. Classroom is set up for child care and furniture and equipment for children is present. Snacks are provided. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. Facility has an outdoor playground waiver to use the playground at park. Staff check the playground before each use. Outdoor play areas inspected for health and safety hazards. The areas around and under high climbing equipment is cushioned with tanbark. Outdoor activity spaces are enclosed by fences and surfaces are free of hazards. Facility has posted all the required licensing forms in a prominent accessible location. LPA reviewed staff and children's files. In the children’s files, each child has Parent's Rights (LIC 995) form and immunization records. Staff have the required immunizations or proof of immunity. Director has verification of the mandated child abuse reporting training as compliant with AB1207 (exp 8/19/2024). Director has current Pediatric First Aid and CPR certification (exp 12/7/2023).

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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: SSFUSD MARTIN CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414001376
	VISIT DATE: 05/30/2023

NARRATIVE

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Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA is 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 the ADA, available at: http://www.ada.gov/childqanda.htm. Facility informed that effective September 1, 2016, a person may not be employed or volunteer at a child care 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.

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.

This report is reviewed with facility representative and a copy of this report must be made available for public review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC809 (FAS) - (06/04)

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