414003031-10-2-2023-05-CC-LGOZ-CW8RG6-20231002130011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414003031
Report Date: 10/02/2023
Date Signed: 10/02/2023 01:00:22 PM

Document Has Been Signed on 10/02/2023 01:00 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	IHSD, INC-LAKEWOOD CDC (PS)		FACILITY NUMBER:	414003031
ADMINISTRATOR:	GHEITH, KIFAH		FACILITY TYPE:	850
ADDRESS:	65 TOWER ROAD		TELEPHONE:	(650) 578-3440
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY:	48	CENSUS: 29	DATE:	10/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Kifah Gheith		TIME COMPLETED:	01:10 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	On 10/2/2023 at 9:15AM., Licensing Program Analysts (LPAs), Luis J. Gomez, Man Tso met with Director, Kifah Gheith. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate two, preschool age classrooms, at the San Mateo County Office of Education Building. Present during inspection was the director and 5 staff supervising 29 children. Children present had been properly signed in. Staff have criminal record clearances on file. Program utilizes two classrooms: Room #5; Room #7, and one, Outdoor Play Area. Outdoor space waiver was observed posted in facility. Per Director, preschool program operates on the 10- month, school year calendar. LPA inspected facility, indoors and outdoors, with director for health and safety hazards. At 9:25AM., LPAs observed the following: Classrooms were clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces were free of any obstructions or hazards. Labeled cubbies were available for storage of children's belongings. Accessible furniture, books, and materials inspected were free of sharp corners or splinters. Classrooms had child- sized tables and chairs for seated activities. LPA observed children’s bathrooms maintained clean. At 9:35AM., Based on observations, LPA confirmed childen's toilet was not in operating condition. Area has been made inaccessible. Advisory Note: Technical Violation (LIC9102) was issued. Staff bathroom is located in hallway. For napping services, labeled cots, mats are stored in each classroom. Napping items inspected were proper repair and made of a cleanable material. Per Director, children napping sheets are washed weekly by staff. Facility has acceptable ventilation and lighting. Disinfectants, toxins, and cleaning compounds have been stored inaccessible to children. Trash bins have been covered. LPA reminded license to ensure all electrical outlets have been covered. Classrooms are equipped with testable smoke/ carbon monoxide combination detector, telephone, and several fully charged fire extinguishers: 2A:10BC. Facility’s first aid kit was reviewed and was fully stocked. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: IHSD, INC-LAKEWOOD CDC (PS)	FACILITY NUMBER: 414003031
	VISIT DATE: 10/02/2023

NARRATIVE

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(Page 2)
At 9:45AM, LPAs inspected the outdoor play area. Area was completely enclosed with tall fencing. Absorbent material had been installed around climbing structure and slide. Covered sandbox was free of any foreign objects. Shaded resting area with fresh water was available for children.

At 9:50AM, LPAs reminded director to ensure outside playthings and equipment are maintained in proper repair. During inspection, director removed broken tricycles from play area. Advisory Note Technical Violation (LIC9102TV) was issued.

During inspection, LPAs reviewed food preparation/storage area. Food items inspected had been properly stored. Area was observed clean, without trash or rubbish.

At 10:30AM LPAs reviewed facility records including 5 children’s files and 5 personnel files. Staff’s files contained the: Notice of Employee Rights (LIC9052); Education Verification; Personnel Record (LIC501); and Required Proof of Immunization.

Staff's ‘Cardiopulmonary Resuscitation and First Aid’ certifications on file were current, expiring: 3/2025.

Children’s files contained the: Consent for Emergency Medical Treatment (LIC627); Immunization Records, Identification and Emergency Information (LIC700); Personal Rights (LIC613A); Notification of Parent’s Rights (LIC995); and ‘Written Medical Assessments’.

At 11:00AM., Based on record review, LPA confirmed Incidental Medical Service plan missing from children files. Advisory Note: Technical Violation (LIC9102TV) was issued.

Emergency disaster drill are conducted monthly. Last drill completed on 8/24/2023, is properly logged.

LPAs observed required posting in facility, including the: Facility License; Emergency Disaster Plan (LIC610); Earthquake Preparedness Checklist; Notification of Parent’s Rights (PUB394); Updated Snack Menu (October); and Child Passenger Safety Laws (PUB369). (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: IHSD, INC-LAKEWOOD CDC (PS)	FACILITY NUMBER: 414003031
	VISIT DATE: 10/02/2023

NARRATIVE

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(Page 3)
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of Medication and equipment/ supplies, and reviewed children’s, personnel and administrative records.

For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed child care centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPAs verified that the lead testing was completed in accordance to the Written Directives outlined in PIN21-21- CCP.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Based on today's inspection, no deficiencies were cited in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations. Exit interview, and report was discussed with Director, Kifah Gheith signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was given and must remain posted for 30 days. Director was advised any additional questions to call office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

LIC809 (FAS) - (06/04)

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