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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003012
Report Date: 09/14/2021
Date Signed: 09/14/2021 12:40:10 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. MATTHEWS EPISCOPAL DAY SCHOOLFACILITY NUMBER:
414003012
ADMINISTRATOR:HUDEC, ERINFACILITY TYPE:
850
ADDRESS:15 2ND AVENUETELEPHONE:
(650) 342-5436
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:34CENSUS: 24DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Erin HudecTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Annual Inspection. LPA met with Site Director Erin Hudec and explained purpose of inspection. Present at the school were the Site Director, 3 teachers, and 24 children (Pre-Kindergarten). School 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 school with Site Director. There are no bodies of water, firearms, or weapons on the premises. The school is in good repair with proper temperature and ventilation and is free of any hazards. All furniture is in good condition. Classrooms have 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. Children bring their own morning snack and lunch. Children also bring their own reusable water bottles and staff refill them throughout the day. Kitchen is clean and free of any toxins or 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. Each classroom has a schedule as to when to use the bathroom. 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.

LPA reviewed children and staff records. Ten children records reviewed were complete. All children have a record of emergency identification information on file. Four staff records reviewed were complete. All staff have a criminal record clearance on file. The Site Director and staff have current Pediatric First Aid/CPR certificates which expire August 2023.

(Continued on second page)
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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 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: ST. MATTHEWS EPISCOPAL DAY SCHOOL
FACILITY NUMBER: 414003012
VISIT DATE: 09/14/2021
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First emergency drill of the school year will be conducted before the end of September 2021. Emergency drills are conducted every month in coordination with the elementary school and are properly logged. The school 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. School phone number is (650) 274-0700. Incidental Medical Services (IMS) was discussed. School currently has no children who need services this school year.

During inspection,
  • Site Director was given updated state and county COVID-19 guidance and PIN 21-21-CCP and forms LIC 9275 and LIC 9276 regarding water lead testing written directives for child care centers.
  • Site 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.
  • Site 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.
  • Site Director was reminded about the Provider Information Notices (PINs) on CCLD website.
  • Site 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 Site 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 MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2