414004018-8-31-2023-05-CC-CQUO-CV8W5Y-20230831165954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004018
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:59:59 PM

Document Has Been Signed on 08/31/2023 04:59 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	HOLY ANGELS PRESCHOOL		FACILITY NUMBER:	414004018
ADMINISTRATOR:	MERLE S LEBAQUIN		FACILITY TYPE:	850
ADDRESS:	20 REINER STREET		TELEPHONE:	(650) 303-1478
CITY:	COLMA	STATE: CA	ZIP CODE:	94014
CAPACITY:	28	CENSUS: 7	DATE:	08/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Sister Merle Lebaquin		TIME COMPLETED:	05:15 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 August 31, 2023, at approximately 2:00PM, Licensing Program Analysts (LPAs) Catrina Quimbo and Jonathan Tse conducted an unannounced annual visit. LPAs were granted entry to the facility by Holy Angels Elementary School Principal. The LPAs then met with the director of the facility, Sister Merle Lebaquin, and explained the purpose of the visit. Present in the facility were Sister Merle, and seven preschool-aged children. LPAs observed the facility to be in compliance with children's capacity and ratio requirements. LPAs observed that required documents are properly posted in the entryway of the facility building. The LPAs and director conducted an inspection of the facility to look for possible threats to health and safety. Preschool program operates at Holy Angel School in Preschool Classroom A and Classroom B. LPAs observed that a fully charged fire extinguisher is present in the facility. There is a fire alarm system placed on the ceiling of the facility. LPAs observed a carbon monoxide detector located in the primary classroom (Classroom A) and upon testing, found it to be operational. LPAs observed that child's desks in the primary classroom are age-appropriate. Children's storage and cubbies are properly prepared and labeled. Children sleep in cots. Garbage cans are observed to be covered with tight-fitting lids. The sinks and toilets are in working condition. LPAs observed the play area to have age-appropriate toys and play structures, with resilient padding surrounding the play structures. There is shade available in the yard. In the event that there is weather preventing children from using the play area, there is an alternative classroom (Classroom B) that is only used for indoor play. Children bring their own food/snacks and water bottles to the facility. There are plastic water bottles and a water dispenser provided if children do not have their water bottles at the facility. *See Page Two*

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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: HOLY ANGELS PRESCHOOL	FACILITY NUMBER: 414004018
	VISIT DATE: 08/31/2023

NARRATIVE

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***Page Two***

Emergency disaster drills are conducted every month. Drills have not been conducted yet as the facility is only two weeks into the school year.

LPAs reviewed the records of five children. Children's records have proof of immunizations. LPAs reviewed the record of the director. Director's First Aid and CPR certification is up-to-date and will expire 08/2025.

Sign in/out sheets are properly maintained and made available for review. During LPAs visit, all children present were signed into program.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

Facility representative was reminded that all adults 18 and over, 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPAs did not observe any accessible water fixtures (water fountains) in the preschool classrooms or preschool outdoor area. Per director, program does not offer a food service or handles food preparation. Per director, children who need their water bottles refilled have access to a water dispenser that is store bought. LPA discussed requirement of waiver submission.

***See Page Three***

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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

FACILITY NAME: HOLY ANGELS PRESCHOOL	FACILITY NUMBER: 414004018
	VISIT DATE: 08/31/2023

NARRATIVE

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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 22-02-CCP. 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-carecenters/.

Facility representative was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Facility was issued Technical Violations for incomplete Mandated Reporter training and incomplete Health Screening forms. No deficiencies were issued today during LPAs visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Sister Merle Lebaquin.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC809 (FAS) - (06/04)

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