414002820-2-16-2024-05-CC-LGOZ-D2J2GX-20240216162351

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002820
Report Date: 02/16/2024
Date Signed: 02/16/2024 04:24:05 PM

Document Has Been Signed on 02/16/2024 04:24 PM - 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:	HIGHLANDS RECREATION DIST. (INFANT)		FACILITY NUMBER:	414002820
ADMINISTRATOR:	LEIN, KRISTEN		FACILITY TYPE:	830
ADDRESS:	1851 LEXINGTON AVENUE		TELEPHONE:	(650) 341-4251
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY:	8	CENSUS: 5	DATE:	02/16/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Interim Director, Stacy Ahlf		TIME COMPLETED:	04:30 PM

NARRATIVE

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On 2/16/2024 at 1:15PM., Licensing Program Analyst, (LPA) Luis Gomez met with Interim Director, Stacy Ahlf. Purpose of the inspection was explained and is for an Unannounced, Random inspection. The combination center was a preschool program on-site. Present was the Interim Director and 3 staff supervising 5 children. Present staff have criminal record clearances of file. The infant program utilizes one room: Monkey Classroom and the Outdoor Play Yard. Day and hours of operation are Monday- Friday, 7:30AM- 6:00PM. The program operates year-round. LPA inspected facility for health and safety hazards.

At 1:25PM., LPA observed the following: Infant classroom was clean and orderly, with age-appropriate playthings available. The floors/ ground surfaces were free of obstructions or possible hazards. Classroom furniture, toys and books inspected were in proper repair. The entry way had several baskets for storage of belongings. The facility’s had a diaper changing table within arm’s reach of a sink. Per Interim Director, area is disinfected after each use. The infant classroom had several chairs and a table for food services.

At 1:50PM., Based on observations, LPA confirmed chipped wall paint, accessible to children in care.

For napping services, LPA observed cribs located separately. All infant cribs had visibility from each side ensuring constant staff supervision. Infant cribs inspected had a properly sized mattress and tight-fitting bedsheets. Per staff, napping linens are washed weekly by staff. The facility was a comfortable temperature with ventilation and lighting. Trash bins and electrical outlets had covering installed. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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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Document Has Been Signed on 02/16/2024 04:24 PM - It Cannot Be Edited

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: HIGHLANDS RECREATION DIST. (INFANT)	FACILITY NUMBER: 414002820
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101239(q)

Fixtures, Furniture, Equipment and Supplies

(q) All materials and surfaces accessible to children, including toys, shall be free of toxic substances. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:50PM., Based on observations, LPA confirmed chipped wall paint, accessible to children in care. This poses a potential health and safety risk to children in care.
	POC Due Date: 03/01/2024
	Plan of Correction
1 2 3 4	Facility will remediate all areas of classroom, where wall paint has chipped, by the due date: 2/26/2024. Proof of correction will be submitted to department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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: HIGHLANDS RECREATION DIST. (INFANT)	FACILITY NUMBER: 414002820
	VISIT DATE: 02/16/2024

NARRATIVE

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(Page 2)
Classroom had a telephone service; smoke/ carbon monoxide combination detectors (built-in); and fully charged fire extinguisher (2A:10BC).

LPA reviewed facility's food preparation area/ refrigerator. The food preparation area was observed clean, free of rubbish or trash. Infant bottles and feeding supplies were correctly stored in the refrigerator. Per director, infant feed bottles and milk is brought by the families daily. LPA observed infant bottles have been labeled with child’s name.

At 2:00PM., LPA inspected the outdoor play area. Area is completely enclosed with absorbent sand installed for added safety. Outdoor play area was free of hazardous plants. Per director, staff provided children with fresh water both inside and outside.

LPA reminded lead teacher to remove all broken equipment and to re- anchor post used for shade in outdoor area. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 2:10PM., LPA reviewed facility records including 5 children’s files and 3 personnel files. Staff files contained the: Notice of Employee Rights (LIC9052); Teacher Qualifications; Personnel Record (LIC701); Proof of Required immunization; and Mandated Reporter Training Certification (AB1207).

Children’s files were reviewed and included the: Infant Needs and Services Plan; Consent for Medical Treatment (LIC627); Identification of Emergency Information (LIC700); Individual Sleeping Plans (LIC9227) for qualifying infants; Immunization Records; and Napping Logs.

Facility staff has documented infant napping conditions, during each 15- minute review.
(REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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: HIGHLANDS RECREATION DIST. (INFANT)	FACILITY NUMBER: 414002820
	VISIT DATE: 02/16/2024

NARRATIVE

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(Page 3)
Facility is conducting emergency disaster drills, with the last drill conducted on 12/16/2023, properly logged.
Staff’s cardiopulmonary resuscitation / first aid certification (CPR) was current, expiring: 11/2024.

Required posting were observed in the facility including the: Facility License; Earthquake Preparedness Checklist; Seat Beat Safety Laws; Notification of Parent’s Rights (LIC995A). LPA advised staff to ensure the LIC610 is updated with current staff.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Interim 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

LPA discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at: http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/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: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.

(REFER TO 809c, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: HIGHLANDS RECREATION DIST. (INFANT)	FACILITY NUMBER: 414002820
	VISIT DATE: 02/16/2024

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(Page 4)
Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12, Chap. 1 Ca. Code of Regulations and cited on 809D. Exit interview, plan of correction, and facility evaluation report was discussed with Interim Director, Stacy Ahlf. Interim Director's signature of this form acknowledges receipt of these documents.

This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC809 (FAS) - (06/04)

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