414002634-7-7-2022-05-CC-HLEG-CG4PR6-20220707113214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002634
Report Date: 07/07/2022
Date Signed: 07/07/2022 11:32:19 AM

Document Has Been Signed on 07/07/2022 11:32 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SBPSD ALLEN ELEMENTARY SCHOOL & PRESCHOOL		FACILITY NUMBER:	414002634
ADMINISTRATOR:	PAUALI MC GUINN, DIRECTOR		FACILITY TYPE:	850
ADDRESS:	500 ACACIA AVENUE		TELEPHONE:	(650) 624-3158
CITY:	SAN BRUNO	STATE: CA	ZIP CODE:	94066
CAPACITY:	15	CENSUS:	DATE:	07/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Pauahi McGinn		TIME COMPLETED:	11:30 AM

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 7/7/2022, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the SBPSD Allen Elementary and Preschool facility. LPA was granted entry by the director, Pauahi McGinn. LPA explained the purpose of the visit to the director. All facility’s staff members have had their criminal background checks cleared by the San Bruno Park School District. During the inspection, LPA observed that the staff and children were not present. LPA and the Director thoroughly checked the facility for potential health and safety hazards. Toys, furniture, and learning materials are all age appropriate in all classrooms. LPA observed that the outside furniture and play structures are in excellent condition. Wood chips surrounds the outdoor play structure, absorbing any accidental falls. Cots are provided for children to use while napping. LPA observed that there were no bodies of water at the facility. All cleaning products, poisons, and other hazardous chemicals have been kept out of reach of children. The facility has smoke detectors, carbon monoxide detectors, fully charged fire extinguishers, centralized smoke alarms, and working phones. According to the director, there are no firearms or weapons in the facility. LPA observed that the facility posted the required documents. (i.e., license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities). Because no staff or children were present during the inspection, no files were reviewed. According to the Director, the Center simulates fire and earthquake drills every six months. *See Page 2 for continuation*

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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: SBPSD ALLEN ELEMENTARY SCHOOL & PRESCHOOL	FACILITY NUMBER: 414002634
	VISIT DATE: 07/07/2022

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

Continued, Page 2
Licensee 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.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA encouraged the Director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

A copy of this report, and the “Notice of Site Visit” were given to the director.

A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with the director, Pauahi McGinn.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2