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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001937
Report Date: 05/03/2023
Date Signed: 05/03/2023 11:24:37 AM


Document Has Been Signed on 05/03/2023 11:24 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:RCSD CHILD DEV SERVICES-HAWES CDCFACILITY NUMBER:
414001937
ADMINISTRATOR:CASTILLO, IVONEFACILITY TYPE:
850
ADDRESS:909 ROOSEVELT AVENUE, ROOM #1TELEPHONE:
(650) 482-2407
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:24CENSUS: 15DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Angeles Abou-SerhalTIME COMPLETED:
11:40 AM
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On May 3, 2023 @ 08:20 AM, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced annual inspection at the RCSD Child. Dev. Services-Hawes CDC site. LPA met with Site Supervisor, Angeles Abou-Serhal and purpose of visit was explained. Facility operates a preschool program in Room #1. Present for today’s visit was Site Supervisor, 2 staff and 16 preschool children. Teacher and children capacity ratio requirements were observed to be in compliance. Program runs two part-time programs from Monday-Friday. Morning program runs from 9:00 AM-12:00 PM and afternoon program from 2:00 PM – 5:00 PM.

LPA and Site Supervisor toured the facility for health and safety hazards. Classrooms is clean with proper ventilation. There are plenty of age-appropriate toys, furniture and learning materials all in good repair. There is a restroom in the classroom with separate toilets for boys and girl. Restroom sinks for washing hands and no running hot water. There is a separate bathroom for staff usage in cafeteria located on premises. Facility outdoor play area has a large play structure in good repair and no safety hazards. Playground is cushioned with green rubber tiles to cushions falls. Outdoor area outside classroom is enclosed with a gate and is also used for outdoor activities. There are no pools, spas, or other similar bodies of water on the premises. Per Site Supervisor, there are no firearms or weapons on site.

The facility provides breakfast and one snack for children which is delivered from another school site. Menus are posted in classroom and changed monthly. Classroom is equipped with a sink and refrigerator. Food is properly stored to avoid contamination. Children have their own labeled water bottles to use inside or outside. Facility offers filtered water to refill water bottles and disposable cups. All cleaning supplies and toxins are properly stored and locked under cabinets and inaccessible to children.

Cont. Page 2...
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
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: RCSD CHILD DEV SERVICES-HAWES CDC
FACILITY NUMBER: 414001937
VISIT DATE: 05/03/2023
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LPA reviewed 5 children’s records and 5 staff records. All children's and staff files were complete with all required documents. Facility has posted the required forms (i.e., License, menus, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law (updated), and Emergency Disaster Plan). No record of water lead testing was available. Type B deficiency issued.

Incidental Medical Services were discussed with Site Supervisor and LPA observed medication to be properly stored, labeled, and inaccessible to children. There are several first aid kits available in the classroom with plenty of medical supplies. Isolation area for sick children is in the office. All storage containers for solid waste have a proper lid. Last emergency drill was conducted on April 19, 2023. Classroom has a complete record of sign-in/out sheets by authorized pickup person. Classroom has a fully charged fire extinguisher and smoke detector which is maintained via School district. LPA reminded Site Supervisor to replace carbon monoxide detector. Facility uses cell phones and has a working telephone landline available on site.

Site Supervisor was reminded that all adults 18 and over living or working in the facility 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.

Site Supervisor 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.

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.

LPA encouraged the Site Supervisor to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Cont. page 3...

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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: RCSD CHILD DEV SERVICES-HAWES CDC
FACILITY NUMBER: 414001937
VISIT DATE: 05/03/2023
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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.

The following Type B violations (potential health, safety, or personal rights risk to children in care.) was cited for today’s visit:

1. Health and Safety Code 1597.16(a)(1)- A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

**The department may clear all violations after the review of the facilities’ Plan of Correction***

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.



Exit interview conducted and report was reviewed with the Site Supervisor, Angeles Abou-Serhal
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/03/2023 11:24 AM - It Cannot Be Edited

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: RCSD CHILD DEV SERVICES-HAWES CDC
FACILITY NUMBER: 414001937

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above ,which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/05/2023
Plan of Correction
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Director will provide a complete LEAD water report from an approved vendor by the above due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-LeonTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5