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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004017
Report Date: 08/26/2022
Date Signed: 08/26/2022 04:04:05 PM


Document Has Been Signed on 08/26/2022 04:04 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:SKYLINE COLLEGE CDC (INFANT)FACILITY NUMBER:
414004017
ADMINISTRATOR:TINA M. WATTS, PROG. DIR.FACILITY TYPE:
830
ADDRESS:3300 COLLEGE DRIVETELEPHONE:
(650) 738-7071
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:20CENSUS: 0DATE:
08/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Nathaliya Gamburg and Julia GoepelTIME COMPLETED:
04:00 PM
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On 8/26/2022, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the Skyline College (Infant) facility. LPA was granted entry by the Program Coordinator, Michelle Amaral. LPA explained the purpose of the visit to the program coordinator. All facility’s staff members have had their criminal background checks cleared by Guardian. During the visit, there were no children present in the facility.

Both LPA and the two teachers thoroughly checked the facility for potential health and safety hazards. The facility has a first aid kit that is fully stocked with all of the necessary supplies for treating injuries. Toys, furniture, and learning materials are all age appropriate in all classrooms. LPA observed that the outside furniture and play structures are in excellent condition. Artificial grass surrounds the outdoor play structures, absorbing any accidental falls. Cribs, cots and resting mats are provided for children to use while napping. LPA observed that there were no bodies of water at the facility. All cleaning products, poisons, and other hazardous chemicals have been kept out of reach of children. The facility has smoke detectors, carbon monoxide detectors, fully charged fire extinguishers, centralized smoke alarms, and working phones. According to the two teachers, there are no firearms or weapons in the facility.

LPA observed that the facility posted the required documents. (i.e., license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities).

Because there were no children in care at the time, the files pertaining to those children were not reviewed.

LPA reviewed the records of three staff members. All required forms were in the staff files. A review of staff records revealed that all staff members are currently certified in CPR and First Aid. lic 8

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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2022
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 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: SKYLINE COLLEGE CDC (INFANT)
FACILITY NUMBER: 414004017
VISIT DATE: 08/26/2022
NARRATIVE
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Continued, Page 2
According to the Program Coordinator, the Infant Center simulates fire and earthquake drills every two months.

The two teachers were 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.

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



Incidental Medical Services (IMS) policy was discussed with the two teachers.. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The LPA encouraged the two teachers to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

A copy of this report, and the “Notice of Site Visit” were given to one of the teachers, Julia Goepel

***See Page 3 for continuation***

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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: SKYLINE COLLEGE CDC (INFANT)
FACILITY NUMBER: 414004017
VISIT DATE: 08/26/2022
NARRATIVE
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Continued, Page 3
A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with one of the teachers, Julia Goepel

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3