414001772-6-22-2023-05-CC-AMEN-CT2UR7-20230622154817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001772
Report Date: 06/22/2023
Date Signed: 06/22/2023 03:48:23 PM

Document Has Been Signed on 06/22/2023 03:48 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:	CARILLON PRESCHOOL		FACILITY NUMBER:	414001772
ADMINISTRATOR:	HELENE, ENID		FACILITY TYPE:	850
ADDRESS:	815 PORTOLA ROAD		TELEPHONE:	(650) 529-1335
CITY:	PORTOLA VALLEY	STATE: CA	ZIP CODE:	94028
CAPACITY:	29	CENSUS: 25	DATE:	06/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Cara Oconnell		TIME COMPLETED:	11:55 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 facility representative for this required annual licensing visit. Purpose of the visit explained. There were 25 children present. Facility meets teacher-child ratios today. Days and hours of operation: Monday through Friday 9:00AM-12:00PM. Physical plant toured, including the classrooms used for the program. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. Separate staff bathrooms are available. No pools, spas, hot tubs, fish ponds, or bodies of water are present. There is a rabbit in a caged area in the outdoor play area. Per staff, 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 in the classrooms. Classrooms are set up for child care and furniture and equipment for children is present. Facility provides snacks; parent's provide the meals for children. First aid supplies are available. Sick children will be separated from the group and wait for parents to pick up in the church office. Outdoor play areas inspected for health and safety hazards. Outdoor activity space surfaces are free of hazards. The areas around and under high climbing equipment is cushioned with tanbark. There is a sandbox in outdoor play area. Drinking water is available by a drinking fountain outside and water pitcher and cups inside. LPA reviewed staff and children's files. In the files reviewed, all records are complete. Facility has posted all the required licensing forms. LPA reviewed staff and children's files. In the files reviewed, all are complete. All staff have verification of the mandated child abuse reporting training as compliant with AB1207. Staff have verification of the required immunizations: measels (MMR) and pertussis (TDap). At least one staff has current Pediatric First Aid and CPR certification. (Continued on next page 809-C)

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: CARILLON PRESCHOOL	FACILITY NUMBER: 414001772
	VISIT DATE: 06/22/2023

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: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC809 (FAS) - (06/04)

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