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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002884
Report Date: 07/11/2019
Date Signed: 07/11/2019 04:12:43 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:PFS-BAYSHORE 87TH STREET CDC (PS)FACILITY NUMBER:
414002884
ADMINISTRATOR:MARILYN LAZANAFACILITY TYPE:
850
ADDRESS:377 - 87TH STREETTELEPHONE:
(415) 330-1715
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY:32CENSUS: 25DATE:
07/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Marilyn LazanaTIME COMPLETED:
04:45 PM
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#2 Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection today. LPA met with the site director, Marilyn Lazana. The purpose of the inspection was explained to her. There were 25 children with 5 staff. The children were napping upon arrival. All the adults were fingerprinted. The facility is in the back of the Broadmoor Presbyterian Church. The operation hours of the center are Monday to Friday from 7:00 AM to 5:45 PM. The preschool program is operated in 2 classrooms (Room 1 & 2). The children from 3 yrs. old or older are in Room #1, & 3 yrs. old or under are in Room #2. LPA inspected the facility for health and safety hazard. The facility was clean and in order. Temperature and lighting were adequate. All toxins and harmful objects were locked and kept inaccessible to children. Children's bathroom was located between classroom #1 & #2, and it was shared by the children from both rooms. The bathroom had 4 toilets and 3 sinks. Toilets and sinks were reachable by children. No harmful or dangerous items were observed in the bathroom during the inspection. Staff bathroom was located on the second floor near the site director office. Cots were available for napping and stored in Classroom #1. Cubbies with children’s names were available for children to store their belongings by the entrance in classroom # 1 & 2. Drinking water was available and served in the pitchers with cups for indoor & outdoor. There were plenty of age-appropriate toys, book, and learning materials available for children in the classrooms. The sand table was available for children indoor as well. All furniture and equipment were age-appropriate and in good condition. There was a mid-size tank with plant in its. A rounded tank with lid had plants and frogs in classroom #1. The carpet was installed to the entire floor as the soft cushioning to prevent injury in both classrooms. All electrical outlets were covered. Doors were used as the barricade at the off-limit area to prevent children access. The food preparation area was located between 2 classrooms. It was barricaded by doors from both sides, so the children cannot access the area. Mechanical Door Chimes were installed to each door to prevent children access to the off-limit areas. The facility provides breakfast, snacks, and lunch. First aid supplies were available in each classroom. The Outdoor play area was completely fenced. There were plenty of age-appropriate outdoor toys, furniture, ride-on toys, sandbox, and play structures with soft rubber material as cushioning underneath to prevent injury. Per site director, there were no guns, no weapons, and no pets in the facility. Per site director, there were some children on special medication. Medication box was kept in the cabinet with a lock in the food preparation area that was located between 2 classrooms. All medication in the box had the child's name on it. The children’s records were reviewed during the inspection. This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies and reviewed children's, personnel, and administrative record. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm. The children file and roster were reviewed during the inspection. LPA also obtained a copy of the roster from licensee during the inspection. All staff met the required staff immunization and Mandated Reporter Training. All required postings were posted.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For a quarterly update on Licensing information, go to the CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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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