414002154-2-2-2022-05-CC-ACON-CB9S9G-20220202124043

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002154
Report Date: 02/02/2022
Date Signed: 02/02/2022 12:41:57 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 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: 12	DATE:	02/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Angela Eugenio and Ingrid Orellana		TIME COMPLETED:	12:55 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 February 2, 2022 at 10:00 AM, Licensing Program Analyst (LPA) Cowan met with Teacher Ingrid Orellana for a 1 Year Required Inspection. Purpose of the inspection was explained. Present, in the facility are 3 staff and 12 children in care. When LPA arrived children were free playing in the yard. At 10:30 AM, site director Angela Eugenio arrived to complete the inspection with LPA. 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 06:00 PM. With director, LPA inspected the day care room and play yard. LPA observed facility has a smoke detector, carbon monoxide detector, 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. The bathroom is in working condition. All storage containers for solid waste fitted lids. All food is stored properly to avoid contamination. 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 cushion material in the play yard to help absorb the impact of falls. There is water available on the yard as well as in the classroom. 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: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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
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: 02/02/2022

NARRATIVE

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LPA observed facility's sign in/out sheet. 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 11/12/21 and is properly logged. At 10:30 AM, LPA reviewed the facility records. LPA reviewed 10 random children's files. Children's records are complete with all required Licensing documents. LPA reviewed 3 random staff's files. At 10:35, LPA observed that staff member did not have a physical file on site. A technical violation is issued this day. LPA discussed the maintenance of staff files with director.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

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.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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
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: 02/02/2022

NARRATIVE

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THIS REPORT HAS BEEN AMENDED
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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.

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

Exit interview conducted and report was reviewed with the [or facility representative] (include name).

This report must be available in the facility for public review. Notice of site visit was observed being posted. 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

The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

A copy of this report was reviewed and will be emailed to the director, Angela Eugenio at EUGENIOA@CI.PACIFICA.CA.US by the close of business on 2/2/22. Confirmation of receipt is required. Signed copy of this report will be stored in the facility file.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

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