414002996-8-31-2021-05-CC-GASL-C6EQUE-20210831122837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002996
Report Date: 08/31/2021
Date Signed: 08/31/2021 12:36:01 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:	ST. MICHAEL PRESCHOOL CENTER		FACILITY NUMBER:	414002996
ADMINISTRATOR:	NIVEN ESCANDER		FACILITY TYPE:	850
ADDRESS:	401 HUDSON STREET		TELEPHONE:	(650) 690-8230
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY:	41	CENSUS: 21	DATE:	08/31/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mary William, Niven Escander		TIME COMPLETED:	01:00 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	A required inspection was conducted today. Analyst inspected the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. A $100.00 civil penalty per person per day up to 5 days (max $500 per person) for the first violation within a 12-month period will be assessed for individuals who do not have fingerprint clearances, are not associated to the facility, or have regular and routine contact with the day-care children. For Subsequent violations within a 12-month period, a civil penalty of $100 person per day up to 30 days (max $3000 per person) will be assessed for individuals who do not have fingerprint clearances, are not associated to the facility or have regular or routine contact with the day-care children. The facility is open 7:45 am- 5:45 pm. The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures (smoke and carbon monoxide detectors present and in working order), Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements. Posting requirements for site visits were also discussed as well as AB 633 requirements. Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov. Staff immunization are on file. Director was reminded that 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. Influenza Declarations were also reviewed.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ST. MICHAEL PRESCHOOL CENTER	FACILITY NUMBER: 414002996
	VISIT DATE: 08/31/2021

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

Director was advised of the required annual pesticides training. For More information about changes to the Healthy Schools Act, templates, articles, and required training you can inspect the DPR website at: https://apps.cdpr.ca.gov/schoolipm/childcare/training/main.cfm Director was also informed of the new requirement effective July 1, 2020 of the required EMSA certified lead poison training. Director was informed about the Provider Information Notices (PINs) on CCLD website. Director was reminded of Mandated Reporter Training available on CCLD website. Training must be renewed every two years.

The facility has an approved waiver on file for outdoor activity space. No more than 37 children can be present on the outdoor space at any given time, since there is not the required square footage needed for the capacity of 41 children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Lead Flyer Requirement Health and Safety Code 1596.7996, mandated that, effective January 1, 2019, CCCs and FCCHs are required to provide parents and guardians of children enrolling or re-enrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations, and options for locations of affordable blood lead tests as specified. A Lead Poisoning Facts Flyer was created, in partnership with the California Department of Public Health (CDPH), to satisfy this requirement. This flyer must be provided to parents and guardians upon enrolling or re-enrolling any child in care.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ST. MICHAEL PRESCHOOL CENTER	FACILITY NUMBER: 414002996
	VISIT DATE: 08/31/2021

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

The following items need to be completed and returned to Licensing by 09/24/21:
-PERSONNEL REPORT (LIC 500)
-EMERGENCY DISASTER PLAN (LIC 610)
-DIRECTOR INFORMATION FOR MARY WILLIAM: DESIGNATION OF ADMIN RESP (LIC 308), PERSONNEL RECORD (LIC 501), HEALTH SCREENING REPORT (LIC 503), IMMUNIZATION RECORD FOR MEASLES, PERTUSSIS AND INFLUENZA DECLARATION, COLLEGE TRANSCRIPTS/DEGREE, SIGNED STATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT SUSPECTED CHILD ABUSE (LIC 9108, SIGNED NOTICE OF EMPLOYEE RIGHTS (LIC 9213) AND CRIMINAL RECORD STATEMENT (LIC 508), PROOF OF COMPLETION OF 16 HOURS PREVENTATIVE HEALTH PRACTICES, INCLUDING CPR AND FIRST AID. PROOF OF COMPLETION OF PESTICIDES TRAINING, PROOF OF COMPLETION OF EMSA LEAD POISON TRAINING, AND PROOF OF COMPLETION OF RECORD KEEPING ORIENTATION.
-UPDATED PARENT HANDBOOK, PERSONNEL POLICIES, DAILY SCHEDULE, ADMISSION AGREEMENT, IMS PLAN.

LPA discussed program’s COVID-19 protocol and required postings. Applicant was informed that access to available Personal Protective Equipment (PPE) may be available through the local child care resource and referral agency.

The requirement for Lead Water Testing was discussed (H&S Code 1597.16). LPA informed the director/licensee to review Provider Information Notice 21-21-CCP (dated 7/28/21) for directives and regulations regarding obtaining a test of the water for lead, and how that information is to be documented and reported to Community Care Licensing.

Report was reviewed and signed by Mary William. Today’s report, 8/31/21, will be sent to maryalmaa@gmail.com by close of business, 8/31/21. Confirmation of receipt is required. No deficiencies were cited
"NOTICE OF SITE VISIT" DOCUMENT WAS GIVEN TO THE DIRECTOR FOR POSTING.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3