414003012-9-20-2022-05-CC-MROZ-CJFP7F-20220920110353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414003012
Report Date: 09/20/2022
Date Signed: 09/20/2022 11:04:01 AM

Document Has Been Signed on 09/20/2022 11:04 AM - 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:	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:	34	CENSUS: 15	DATE:	09/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Erin Hudec		TIME COMPLETED:	11:30 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 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, one teacher, and 15 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 5:00pm. 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. A first aid kit is available at the school. 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. Last emergency drill was conducted on September 9, 2022. Emergency drills are conducted once a month and are properly logged. Sign-in/out sheets are done electronically. The school has a complete electronic record of sign-in/out sheets by authorized pickup person. There is a working sprinkler and fire alarm system throughout the school. A carbon monoxide detector and a fully charged fire extinguisher are in each classroom and a working telephone is available on-site.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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: ST. MATTHEWS EPISCOPAL DAY SCHOOL	FACILITY NUMBER: 414003012
	VISIT DATE: 09/20/2022

NARRATIVE

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Eleven children records reviewed were complete. All children have a record of emergency identification information on file. Two 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.

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

Facility representative 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.

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.

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.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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. MATTHEWS EPISCOPAL DAY SCHOOL	FACILITY NUMBER: 414003012
	VISIT DATE: 09/20/2022

NARRATIVE

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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 was conducted and report was reviewed with Facility Representative Erin Hudec.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC809 (FAS) - (06/04)

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