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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002154
Report Date: 02/07/2020
Date Signed: 02/07/2020 09:16:49 AM

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 PRESCHOOLFACILITY NUMBER:
414002154
ADMINISTRATOR:ANGELA EUGENIOFACILITY TYPE:
850
ADDRESS:5066 PALMETTO AVENUETELEPHONE:
(650) 738-7463
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY:30CENSUS: 17DATE:
02/07/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Mindy TietTIME COMPLETED:
09:30 AM
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On February 7, 2020 at 8:15 AM, Licensing Program Analyst (LPA) April Cowan conducted an CASE MANAGEMENT inspection and met with director. The purpose of the inspection was explained and LPA was granted entry. In the facility this day is Director, three staff, and 17 children.
LPA observed the following: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. Center has sufficient lighting and ventilation. Center has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. There are no bodies of water in the Home. There are no poisons, detergents, or cleaning products accessible to day-care children.
Today, LPA inspected temporary play yard for children. Yard measures 1,848 square feet. Yard is fenced with metal fence panels that are six feet high. Yard has a basket ball hoop near the center of the south facing fence. Although center's capacity is 30, center only has 24 enrolled and will only need the temporary space until March 31, 2020. Center will take canopy to yard daily for shade.

LPA is recommending approval for temporary play yard for children until April 1, 2020.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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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