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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004115
Report Date: 06/16/2022
Date Signed: 06/16/2022 03:12:17 PM


Document Has Been Signed on 06/16/2022 03:12 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:PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INFFACILITY NUMBER:
414004115
ADMINISTRATOR:JENNY HOBSONFACILITY TYPE:
830
ADDRESS:1311 SO. EL CAMINO REALTELEPHONE:
(650) 340-7241
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:24CENSUS: 14DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Jenny HobsonTIME COMPLETED:
03:20 PM
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On 6/16/2022 at 10:10AM., Licensing Program Analyst, Luis J. Gomez met with Director, Jenny Hobson. Purpose of the inspection was explained and was for an unannounced; Annual Random inspection. This is a combination center with a preschool program on-site. Present was director and seven staff supervising 14 children. Children present have been signed in. All staff had their criminal record clearance of file. Infant program utilizes two classrooms: Caterpillar (1-2 year old), Cocoon (0- 1 year old); and one, shared the Outdoor Play Yard. LPA observed outdoor space waiver posted in facility lobby. Days and hours of operation are: Monday- Friday 8:30AM- 6:00PM. Program operates year-around. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

At 10:20AM., the following was observed: Infant classrooms were clean, orderly, and with a variety of age-appropriate playthings available for the children. Furniture and toys inspected were in good repair. Floors and ground surfaces were free of obstructions. Classrooms had ample storage for children’s belongings. Classrooms were equipped with diaper changing tables, located within arm’s reach of a sink. Per director, changing tables are disinfected by staff after each use. Food preparation area had been made inaccessible. LPA observed milk and food items in "Cocoon" classroom were labeled with children's names and properly dated. For napping services, infants each had their own crib/ cot with tight-fitting sheet. Infant cribs had visible sides for constant staff supervision. Per director, children’s napping linins and sheets are washed daily. Facility maintains required napping logs for children under 24 months of age. Classrooms had adequate ventilation and lighting. Trash bins and outlets were properly covered. (REFER TO 809C FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF
FACILITY NUMBER: 414004115
VISIT DATE: 06/16/2022
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Detergents, spray bottles, and sharp objects were made inaccessible. Facility had functioning telephone service, smoke/ carbon monoxide detector combo, and fully charged fire extinguisher (2A:10BC) located in hallway.

At 10:45AM., LPA inspected outdoor play area. Enclosed area was located completely separate and equipped with turf flooring for added safety. LPA observed area was clean and free of any potential hazards. Outdoor playthings inspected were in good repair. Per director, the sandboxes are covered at the end of each day. For water services, large, plastic jugs are refilled daily by classroom staff.

At 11:50AM., LPA review 10 children’s records and 7 personnel records. Staff records were reviewed and included: Mandated Reporter Training Certification; Required Proof of Immunization; Required Teacher Transcripts; Notice of Employee Rights (LIC9052); and the Criminal Record Statement (LIC508). Present staff members had their current CPR/ Fist Aid certification on file, which expire 8/27/2023.

Children’s records were reviewed and included: (LIC503) Health History; (LIC627) Consent for Medical Treatment; (LIC700) Identification of Emergency Information; (LIC995A) Notification of Parent’s Rights, (LIC613A) Personal Rights; Immunization Records; and Admissions Agreement. Signed ‘Individual Infant Sleep Plan’ (LIC9227) had been stored in children’s files for all qualifying infants in care.

Required Emergency Disaster Drills are being conducted at the facility; last drill completed on, 5/11/2022, was properly logged.



Program provide daily snack and meals for day-care children. Facility kitchen was review during inspection.

All required posting are posted in the facility lobby including: Facility License, Notification of Parent's Rights, and Emergency Disaster Plan.
(REFER TO 809C, FOR CONT.)
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF
FACILITY NUMBER: 414004115
VISIT DATE: 06/16/2022
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

LPA discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview conducted and report reviewed with Director, Jenny Hobson and signature of this form acknowledges receipt of these documents.



This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility 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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3