414002884-1-17-2024-05-CC-CQUO-CZKRD7-20240117115527

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002884
Report Date: 01/17/2024
Date Signed: 01/17/2024 11:55:32 AM

Document Has Been Signed on 01/17/2024 11:55 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:	PFS-BAYSHORE 87TH STREET CDC (PS)		FACILITY NUMBER:	414002884
ADMINISTRATOR:	MARILYN LAZANA		FACILITY TYPE:	850
ADDRESS:	377 - 87TH STREET		TELEPHONE:	(415) 330-1715
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	32	CENSUS: 29	DATE:	01/17/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Marilyn Lazana		TIME COMPLETED:	12:15 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 January 17, 2024 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted an unannounced, annual inspection. LPA met with director, Marilyn Lazana, and explained the purpose of the inspection. Present during LPA's visit included 29 preschool children, 6 teaching staff (including director), and a PFS family coordinator. All staff present have fingerprint clearance on file. Facility is a preschool program that operates in Room 1 (4-5 year olds) and Room 2 (3 year olds). Hours of operation are Monday through Friday 7:00am to 5:30pm. LPA inspected the facility, indoors and outdoors, for health and safety hazards. LPA observed both classrooms to be equipped with age appropriate materials, toys and furniture. Flooring in classrooms include carpets that were observed to be clean. Children's classrooms have a variety of toys and materials that were in good condition. Storage for children's belongings are located inside the classroom, labeled with children's individual names. Classrooms are appropriately ventilated. LPA did not observe accessible poisons, chemicals or cleaning solutions in either classrooms. Both classrooms are equipped with a fully charged fire extinguisher, fire alarm system and dual smoke/carbon monoxide detectors. LPA was unable to test carbon monoxide detector in classrooms as detectors were placed in classrooms' high ceilings. Per director, fire department visited facility week of 1/8 and tested detectors. Per director, detectors in classrooms are working. There is a shared bathroom between the classrooms that includes 3 sinks and 4 toilets. LPA observed bathrooms to be in working condition. Garbage bins were observed to have tight fitting lids. Bathroom is equipped with appropriate sanitation materials and appropriate toileting equipment. Facility also includes a shared kitchen/food preparation area that is made off limits to children with gates. LPA observed kitchen area to be clean and menu to be properly posted. Program provides a food service that includes morning snack, lunch and afternoon snack. Per director, program utilizes a third party vendor that delivers food daily. (Continue on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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 87TH STREET CDC (PS)	FACILITY NUMBER: 414002884
	VISIT DATE: 01/17/2024

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...)
Children sleep on cots that are appropriately stored. Children's sheets are stored in bins that are labeled with their individual names, to avoid sheets from touching.

Outdoor area is entirely enclosed and fenced. There are a variety of outdoor toys and materials that were observed to be in good condition. There is a play structure in the outdoor area with resilient padding underneath. LPA observed a sandbox in the outdoor area that includes a sandbox cover. Storage sheds in outdoor area were observed to be locked and include children's materials. LPA did not observe any pools, spas or bodies of water on site.

Water is made available to children indoors and outdoors through their individual water bottles. LPA observed children's water bottles to be appropriately stored and labeled. Children's water bottles can be refilled on site through the kitchen area with a filtered sink.

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.

LPA verified that the lead testing was completed in accordance to the Written Directives
outlined in PIN 21-21.1-CCP.

Licensing documents were observed to be properly posted and made available for review in both classrooms. A child care roster is maintained and was made available for review during visit. Emergency drills are conducted and are properly documented. Last disaster drill was conducted 01/12/2024. Children are signed into and out of program with electronic signatures. LPA observed children present to be appropriately signed into program. Director was able to provide LPA with a sign in/out record on a random day from previous month. LPA observed sign in/out records from previous month to also have children appropriately signed into and out of program.

LPA reviewed facility records that included 10 random children's records and 8 random staff records. LPA observed children's records to be complete with record of emergency information. Staff files were also observed to be complete with proof of required immunizations, educational transcripts and/or teaching permits and current Mandated Reporter certificates. Director was reminded Mandated Reporter training must be renewed every 2 years by all staff who work with children. Multiple staff on site have a current CPR/First Aid certification that will expire in 2025. Multiple staff on site are also scheduled to renew their CPR/First Aid certification 1/20/2024.

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
(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: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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 87TH STREET CDC (PS)	FACILITY NUMBER: 414002884
	VISIT DATE: 01/17/2024

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...)
Director 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.

LPA discussed the safe sleep regulations with director and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

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/

Director 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 during today'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 director, Marilyn Lazana.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3