414002154-1-9-2023-05-CC-ACON-CMWUKV-20230109143945

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002154
Report Date: 01/09/2023
Date Signed: 01/09/2023 02:40:11 PM

Document Has Been Signed on 01/09/2023 02:40 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CITY OF PACIFICA-FAIRMONT WEST PRESCHOOL		FACILITY NUMBER:	414002154
ADMINISTRATOR:	ANGELA EUGENIO		FACILITY TYPE:	850
ADDRESS:	5066 PALMETTO AVENUE		TELEPHONE:	(650) 738-7463
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY:	30	CENSUS: 15	DATE:	01/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:54 PM
MET WITH:	Angela Eugenio		TIME COMPLETED:	03:00 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 January 9, 2023 at 12:54 PM, Licensing Program Analyst (LPA) Cowan met with director, Angela Eugenio for a 1 Year Required Inspection. Purpose of the inspection was explained. Present, in the facility are director, 3 staff, and 15 children in care. Facility is operating within its capacity, and facility is in compliance with staff / child ratio on this day. Facility operates day care Monday to Friday from 07:00 AM to 6:00 PM. When LPA arrived, children were napping. With director, LPA inspected the day care rooms. LPA observed facility has installed smoke detector, carbon monoxide detector (these devices were not tested due to children napping), fully charged fire extinguisher, and working telephone on site. All cleaning solutions, poisons and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Facility floor is in good repair and free of any hazards. There are first aid supplies available in the classroom. All bathrooms are in working condition. All storage containers for solid waste fitted lids. Facility has a sufficient amount of sleeping matts available. Food preparation area is free of litter. Food is stored adequately to prevent contamination. Play yard is free of hazards. There is a sufficient amount of poured rubber to help absorb the impact of falls. There is water available on the yard as well as in the classroom. LPA observed facility's sign in / out process. LPA observed that parents are using full signatures. Facility has license and all other required documents posted and visible for the public. There are menus posted at least one week in advance and are visible to the child's authorized representative. Facility’s last emergency drill was conducted 12/29/22, and is properly logged. At 1:26 PM, LPA reviewed the facility records. LPA reviewed 5 random children's files and 3 staff files. All files are complete with all required Licensing documents. Per director, all contact information of file is current. Report continues on next page……….

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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 2

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: CITY OF PACIFICA-FAIRMONT WEST PRESCHOOL	FACILITY NUMBER: 414002154
	VISIT DATE: 01/09/2023

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
26
27
28
29
30
31
32

Page 2
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 the ADA, available at: http://www.ada.gov/childqanda.htm

Facility has IMS policy on file with Regional Office.

Director was reminded that all adults 18 and over, 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 Child Care Center. 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.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file. LPA encourages 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/inspection-process.

>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.

Exit interview is conducted, and report was reviewed with site director, Angela Eugenio. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit is to be posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2