414003003-3-24-2022-05-CC-MROZ-CCTRRY-20220324131556

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414003003
Report Date: 03/24/2022
Date Signed: 03/24/2022 01:16:03 PM

Document Has Been Signed on 03/24/2022 01:16 PM - It Cannot Be Edited

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:	PACIFIC RIM INTERNATIONAL SCHOOL (INF)		FACILITY NUMBER:	414003003
ADMINISTRATOR:	CHRISTINIA CHEUNG, EXEC DR		FACILITY TYPE:	830
ADDRESS:	454 PENINSULA AVENUE		TELEPHONE:	(650) 685-1881
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	12	CENSUS: 3	DATE:	03/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rita Tang		TIME COMPLETED:	01:30 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	Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced Annual inspection. LPA met with Administrative Director Rita Tang and explained purpose of inspection. The center is a combination center with an infant program and a preschool program with a toddler component. Both programs operate under a separate license. Pacific Rim International School operates under license #414000415. Present in the Nido Room were 2 staff and 3 infants. Center is operating within capacity requirements and in compliance with child to staff ratio. Hours of operation are Monday to Friday from 8:00am to 6:00pm. LPA inspected the Nido Room and outdoor play area with Administrative Director. There are no bodies of water, firearms, or weapons on the premises. The center is in good repair with proper temperature and ventilation and is free of any hazards. All furniture is in good condition. Classroom has age appropriate toys and equipment. Room has a separated area designated for napping. Napping equipment includes mats and cribs which are in good condition. Mats are properly stored when not in use. A first aid kit is available in the classroom. All cleaning products and toxins are inaccessible to children. Outdoor play area is fenced for supervision. The outdoor toys and equipment in the play area are age appropriate and in good condition. All required postings and waiver are properly posted in the bulletin board in front of the office. Menu is posted for the whole month. Center provides a hot lunch and snacks. Lunch is cooked in-house by a chef. Kitchen is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. Bathroom area has one toilet and one sink for children use with additional potty chairs. Bathroom area appears to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises. There is a changing table and a sink for staff to wash their hands. Changing area is kept clean, in good repair, and maintained with adequate supplies. Changing table is disinfected after every use. (Continued on next page)

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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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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: PACIFIC RIM INTERNATIONAL SCHOOL (INF)	FACILITY NUMBER: 414003003
	VISIT DATE: 03/24/2022

NARRATIVE

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Last emergency drill was conducted in March 2022. Emergency drills are conducted monthly and are properly logged. Sign-in/out sheets are done electronically. The center has a complete electronic record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system throughout the center. There is a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available on-site.

Three children records reviewed were complete. All children have a record of emergency identification information on file. Each child has an individual infant safe sleep plan and a current needs and services plan. Three staff records reviewed were complete. All staff members have a criminal record clearance on file. Administrative Director and staff have a current Pediatric First Aid/CPR certificate which expires January 2023.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

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, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (US DOJ) 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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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: PACIFIC RIM INTERNATIONAL SCHOOL (INF)	FACILITY NUMBER: 414003003
	VISIT DATE: 03/24/2022

NARRATIVE

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Facility Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Facility Representative 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Facility Representative Rita Tang.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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