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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002154
Report Date: 05/12/2020
Date Signed: 05/12/2020 02:48:31 PM

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: 0DATE:
05/12/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tracy GilbertTIME COMPLETED:
03:00 PM
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On May 12, 2020 at 2:00 PM, Licensing Program Analyst (LPA) Cowan met with Program Director for a case management inspection of newly installed outdoor play structure and surface. Due to COVID-19 Shelter-in-Place, this inspection was conducted via Facetime. Facility is currently closed and there are no children in care.

LPA inspected the out door play area for health and safety hazards. LPA observed a large structure in the middle of the yard with multiple slides, climbing structures, ground level balance beam, and other age appropriate activities. LPA observed outdoor area has adequate shade over play structure. Facility also uses a portable canopy for additional shade for children to rest under. Equipment and activity areas are arranges so that there are no hazards for conflicting activities. The surface of the outdoor space is made of rubber mats and is free from hazards. There are no pools or sand boxes on premises. The yard is completely fenced and fence is at least four feet tall.

On this day outdoor play area is licensed and approved for child care.

A copy of this report will be emailed to program director with Read Receipt.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2020
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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