414003012-2-6-2020-05-CC-MROZ-BLJPK7-20200206102240

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414003012
Report Date: 02/06/2020
Date Signed: 02/06/2020 10:22:52 AM

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. MATTHEWS EPISCOPAL DAY SCHOOL		FACILITY NUMBER:	414003012
ADMINISTRATOR:	HUDEC, ERIN		FACILITY TYPE:	850
ADDRESS:	15 2ND AVENUE		TELEPHONE:	(650) 342-5436
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	20	CENSUS: 14	DATE:	02/06/2020
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Erin Hudec		TIME COMPLETED:	10:40 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) Marie Rodriguez conducted an unannounced Annual Required inspection. LPA met with Site Director Erin Hudec and explained purpose of inspection. Present in center were the Director, 2 teachers, and 14 children (Pre-Kindergarten). Center is operating within capacity requirements and in compliance with child to staff ratio. Hours of operation are Monday to Friday from 8:15am to 2:15pm with extended care hours from 7:30am to 8:15am and 2:15pm to 6:00pm. LPA inspected center with Site 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. Napping equipment is in good condition and properly stored when not in use. Outdoor play area is fenced for supervision. Outdoor toys and equipment are age appropriate and in good condition. Play structures are age appropriate and in good repair. There is adequate cushioning underneath the play structures. All required postings are properly posted next to the entrance of the center. Parents are assigned to bring snacks for the children each day and a calendar is posted showing which day is assigned to whom. Children bring their own lunch. 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. All cleaning products and toxins are inaccessible to children. Bathroom has two toilets and three sinks. 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. At 8:50am, LPA reviewed children and staff records. Four children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff members have a criminal record clearance on file. The Director and staff have current Pediatric First Aid/CPR certificates which expire August 2021. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

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: ST. MATTHEWS EPISCOPAL DAY SCHOOL	FACILITY NUMBER: 414003012
	VISIT DATE: 02/06/2020

NARRATIVE

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(Continued from first page)

Last emergency drill was conducted in January 2020. Emergency drills are conducted every month in coordination with the school and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a functional fire alarm system, a working fire and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone is available on-site. Phone number is (650) 274-0700. Incidental Medical Services (IMS) was discussed. Center currently has no children who need services this school year.

During inspection,

Director was given information regarding Technical Support Program (TSP), Required Lead Testing for Drinking Water in Child Care Centers, and Lead Poisoning Facts Flyer.
Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.
Director was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available and filed in staff record.
Director was reminded about the Provider Information Notices (PINs) on CCLD website.
Director was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

No deficiencies cited today.

This report was reviewed and discussed with Director Erin Hudec. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

LIC809 (FAS) - (06/04)

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