<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002946
Report Date: 11/25/2019
Date Signed: 11/25/2019 11:43:02 AM

COMPREHENSIVE INSPECTION
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:TRINITY LUTHERAN PRESCHOOLFACILITY NUMBER:
414002946
ADMINISTRATOR:ANGELINA V. CORPUZFACILITY TYPE:
850
ADDRESS:1505 SHERMAN AVENUETELEPHONE:
(650) 580-2349
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:28CENSUS: 17DATE:
11/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Angelina CorpuzTIME COMPLETED:
11:50 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
Licensing Program Analyst (LPA) Van met with Director, Angelina Corpuz for an unannounced annual random inspection. The purpose of the inspection was explained and was granted entry to the facility by the director. This is a preschool program. Present today are 17 children with 3 teachers. Staff to children ratio are met. Days and hours of operations are from Monday - Friday 8:00 AM - 6:00 PM. There are four classrooms; a common area room, the Math/Science room, the language room/Sensorial room, and the Care room.

Per director, there are no firearms, weapons or pets at the center. Sick children will be separated from the group and waited in the kitchen for parents to pick up. Per director, the center provides two snacks, and lunch for children. Water bottles are brought from home and readily available for children. Director stated Fire and Earthquake drills are done on monthly basis, the last fire drill was completed on 11/21/19.

With director, LPA inspected the facility for health and safety hazards. LPA observed the following;
  • Facility has a sign in / out record with full legal signatures from parent or authorized representative.
  • The facility is in good repair, free of any hazards, and has proper temperature, lightning, and ventilation.
  • Variety of age appropriate toys and learning materials for children are available.
  • Furniture, equipment, sufficient amount of sleeping mats for children are available, and mats are stored properly. (blankets, and sheets are return to parents on Friday to be wash)
  • All children's chairs and table have rounded corner.
  • There are no pools, spas or other bodies of water at the facility.
  • Facility has 2 toilet and 2 sinks, all toilets and sinks are clean and well sanitized.
  • Facility has smoke detector, multiple carbon monoxide detectors, fully charged fire extinguisher and a working telephone at the site.
  • All cleaning solutions, poisons and other chemicals that are dangerous stored inaccessible to children.
Continued on the next page...
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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: TRINITY LUTHERAN PRESCHOOL
FACILITY NUMBER: 414002946
VISIT DATE: 11/25/2019
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
  • Food preparation area is clean, organize, and foods store appropriately.
  • Outdoor playground area is in good repair. Play structures are free of any loose parts, and small sandbox is inspected daily.
  • There are menus and daily activities posted.
  • Facility has posted the required forms (i.e. License, menus, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan).

The following records were reviewed:
  • All staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
  • Director has record of valid Pediatric FirstAid/CPR card in file.
  • Staff have the required immunization, and verification of the mandated child abuse reporting training as compliant with AB1207.
  • Incidental Medical Service (IMS), LPA reviewed medications storage, and discussed with director paperwork needed on the child's plan.
  • All children had a medical assessment and required licensing forms were completed. Medication Policies, Isolation of Sick Children, and Napping Requirements.

The following were discussed with Director:
  • Provider Information Notices (PINs) on CCLD website, Mandated Reporter Training, and Immunization (as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662). 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 publication. Pesticides training was also discussed (Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare),
  • LPA went over the Child Care Center checklist, and provided a copy to the Director during the inspection

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2