414002882-8-30-2023-05-CC-CQUO-CV7PNS-20230830112825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002882
Report Date: 08/30/2023
Date Signed: 08/30/2023 11:28:33 AM

Document Has Been Signed on 08/30/2023 11:28 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	PFS-BAYSHORE OUR SECOND HOME CDC (PS)		FACILITY NUMBER:	414002882
ADMINISTRATOR:	ZEYNEP BASAK		FACILITY TYPE:	850
ADDRESS:	725 PRICE STREET		TELEPHONE:	(650) 301-3304
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY:	16	CENSUS: 7	DATE:	08/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Flor Hernandez		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 August 30, 2023 at approximately 8:40am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with site supervisor, Flor Hernandez, and explained the purpose of the inspection. At start of LPA's visit, no children were present yet. Program is a part time program that operates from the fall through the summer of each year. Hours of operation are Monday through Friday 9:00am to 12:00pm. LPA inspected the facility, indoors and outdoors, for health and safety hazards. Program operates at Our Second Home facility in one classroom only. Program includes the Peninsula Family Services (PFS) classroom and an outdoor area. LPA observed classroom to be clean, equipped with age appropriate toys and materials. Classroom includes separate areas for dramatic play, manipulative materials and a quiet reading section. Storage for children's belongings are located in the classroom, labeled with children's individual names. At approximately 9:00am, children were being signed into program. LPA observed 7 preschool children with 2 teaching staff and a PFS family coordinator. Program is operating within capacity limits and ratio during LPA's visit. Staff present have fingerprint clearance on file. LPA observed facility to have an installation of a fire alarm system throughout the building. PFS classroom is equipped with a fully charged fire extinguisher and a fully stocked first aid kit. Classroom is also equipped with multiple smoke and carbon monoxide detectors in classroom's high ceilings. LPA observed detectors, however, was unable to test smoke and carbon monoxide detectors in high ceilings. LPA observed poisons, cleaning solutions and hazardous materials are stored inaccessible to children, in classroom's high shelves. Cabinets and drawers in classroom were observed to have child safety locks installed. Electrical outlets were observed to be made inaccessible with child safety covers. Doors exiting the classroom were observed to have an alarm sound system. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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 3

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: PFS-BAYSHORE OUR SECOND HOME CDC (PS)	FACILITY NUMBER: 414002882
	VISIT DATE: 08/30/2023

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...)
There is a bathroom for children in the classroom that includes 2 toilets. There are multiple accessible sinks for children's use. Sinks accessible to children do not provide water that is warmer than 120 degrees Fahrenheit. LPA observed toilets and sinks to be in proper working condition. Classroom is equipped with a garbage bin with a tight fitting lid.

Program currently provides a food service that includes snack only. LPA observed menu to be properly posted in classroom. Water is available to children, indoors and outdoors, with children's water bottles that can be refilled at the facility through a water fountain.

Outdoor area PFS program utilize is located next to classroom. Outdoor area is entirely enclosed and fully fenced. There are a variety of outdoor toys and equipment that were in good working condition. There is a play structure in the outdoor area that was observed to have resilient padding underneath.

LPA reviewed facility records that included 7 children's records and both teaching staff whom were present during LPA's visit. LPA observed children's and staff's records to be complete. Children's files have a record of emergency information on file. At least one staff member present on site has a current CPR/First Aid certification. Both teaching staff on site have their required immunizations that were made available for review.

Children are signed in and out of facility by authorized representatives' written signatures. Program has license documentation and information properly posted and available for review. PFS program resumed operations 08/14/2023. Program has not yet completed emergency disaster drill. Per site supervisor, emergency disaster drills are conducted every month and are documented.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Site supervisor was reminded that all adults 18 and over, including
employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PFS-BAYSHORE OUR SECOND HOME CDC (PS)	FACILITY NUMBER: 414002882
	VISIT DATE: 08/30/2023

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 3...)
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. Site supervisor provided proof of program's lead water testing to LPA during visit.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Site supervisor was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California

No deficiencies were cited today during LPA's visit.

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

Exit interview conducted and report was reviewed with the site supervisor, Flor Hernandez.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3