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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001772
Report Date: 08/27/2019
Date Signed: 08/27/2019 11:48:44 AM

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:CARILLON PRESCHOOLFACILITY NUMBER:
414001772
ADMINISTRATOR:HELENE, ENIDFACILITY TYPE:
850
ADDRESS:815 PORTOLA ROADTELEPHONE:
(650) 529-1335
CITY:PORTOLA VALLEYSTATE: CAZIP CODE:
94028
CAPACITY:29CENSUS: 26DATE:
08/27/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Enid HeleneTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Singh met with director, Enid Helene, for a random annual inspection. Purpose of the inspection was explained. Present, there are 26 children with four teachers and the director. Facility is operating with in the capacity and in compliance with staff child ratio on this day. Facility operate day care from Monday to Friday between 9 AM to 1 PM.

With director, LPA inspected the day care areas. There are no pools, spas or other bodies of water at the facility. LPA observed facility has combination of smoke detector and carbon monoxide detectors installed. Facility has multiple fully charged fire extinguisher and medical supplies available on site. There is working telephone at the site. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Cabinets with chemicals has child protective locks installed. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. All toilets, hand washing facilities are in working condition with proper sanitation in place. All storage containers for solid waste and in good repair and have proper lid on top. Facility has drinking water available for children. Per director, children bring their own meals. Food preparation area is free of litter. Play yard is free of hazards. Play structure is in good repair and free of any loose parts.

At 11 AM, LPA reviewed the facility records. LPA observed that facility has sign in / out record with full legal signatures. LPA observed facility has all of required documents posted. Per director, facility conduct the fire and emergency drills every month. Per director, because facility opened this week after summer off, the drill be conducted within ten days. Per facility log, previous drill was conducted on March 19,2019. LPA reviewed eight random children's and four teacher's files.

See next page for continuation .......
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
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 3
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: CARILLON PRESCHOOL
FACILITY NUMBER: 414001772
VISIT DATE: 08/27/2019
NARRATIVE
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Continuation from previous page ........

LPA reminded the director that 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. The facility was informed about this regulation during previous annual inspection. During today’s inspection, LPA did not observed the record of immunization of current staff.

LPA reminded the director that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

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

See next page for deficiencies are cited today. 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.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CARILLON PRESCHOOL
FACILITY NUMBER: 414001772
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2019
Section Cited

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1596.7995 (a)(1) - Employees or volunteers at day care center; immunization requirements; records; exemptions : Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
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This requirement is not met as evidenced during the record review, LPA did not observed the immunization record of present staff. This poses a potential Health and Safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3