414002584-6-25-2024-05-CC-JGIL-D6KPM2-20240625112538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002584
Report Date: 06/25/2024
Date Signed: 06/25/2024 11:25:44 AM

Document Has Been Signed on 06/25/2024 11:25 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	LITTLE BLOOM CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	414002584
ADMINISTRATOR:	KYRA DE GUZMAN		FACILITY TYPE:	850
ADDRESS:	1911 ELKHORN COURT		TELEPHONE:	(650) 638-9300
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	73	CENSUS: 36	DATE:	06/25/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Kyra Pamela De Guzman		TIME COMPLETED:	12:00 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 June 25, 2024 at approximately 8:45 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual required inspection. LPA met with director, Kyra Pamela De Guzman, and explained the purpose of the inspection. Facility is a combination center with a preschool and infant license. Present during inspection included 36 preschool age children and 10 staff members (including director). Facility is operating within capacity requirements and ratios on this date. Hours of operation are Monday to Friday, 8:00 AM to 5:30 PM. With director, LPA inspected entire facility, indoors and outdoors for health and safety hazards. Facility is a single level facility with 6 classrooms. There is 2 classrooms for the infant license and 4 classrooms for the preschool license. Preschool classrooms include Papillons, Ladybugs, Bumblebees, and Butterflies. LPA observed classrooms to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located inside each classroom, labeled with each child's individual names. Facility has an installation of a fire alarm system throughout the entire building. Facility has multiple fully charged fire extinguishers and fully stocked first aid kits in each classroom. Medication is stored appropriately in classrooms in out of reach first aid containers or children cubbies. Medication is stored inaccessible to enrolled children and maintained in original packaging with proper documentation. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility's high shelves. LPA observed children's bathrooms to be clean and in proper working condition. Facility currently provides a food service that includes breakfast and afternoon snacks. Lunch is provided by enrolled children's parents or authorized representatives. Lunch program is made available if needed by facility. LPA observed kitchen and food prep area to be clean and orderly. Children's individual containers are properly labeled with children's individual names. Water is available to children indoors and outdoors with children's water bottles, labeled with child's individual names and water pitchers with disposable cups. Continue Report on Page 2...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LITTLE BLOOM CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414002584
	VISIT DATE: 06/25/2024

NARRATIVE

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Outdoor area was observed to be equipped with age appropriate materials that were in working condition. There is shaded area outdoors for children in care. Children are signed in and out of facility by their authorized representatives'/parents electronic signatures on Pro Care App. Facility has license documentation and information properly posted and available for review throughout the facility. LPA observed sufficient labeled sleeping cots for children in care.

LPA reviewed facility records that included 10 children's records, 9 staff records that were present during inspection. LPA observed children's and staff's records to be complete. Multiple staff members present during inspection have valid CPR certificates that will expire 08/31/2025. Emergency drills are conducted at least once every six months and are properly logged and documented. Last emergency drill was conducted 04/22/2024.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care 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.

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 completed certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

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.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LITTLE BLOOM CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414002584
	VISIT DATE: 06/25/2024

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LPA discussed the safe sleep regulations with executive director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

No deficiencies were issued under CCR, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with director, Kyra Pamela De Guzman.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024

LIC809 (FAS) - (06/04)

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