414004132-12-17-2019-05-CC-CINO-BJXSGA-20191217125137

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004132
Report Date: 12/17/2019
Date Signed: 12/17/2019 12:51:41 PM

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:	ALL FIVE @ BELLE HAVEN (PS)		FACILITY NUMBER:	414004132
ADMINISTRATOR:	CAROL THOMSEN		FACILITY TYPE:	850
ADDRESS:	415 IVY DRIVE, PTBL 15		TELEPHONE:	(650) 387-8268
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	24	CENSUS: 19	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Director, Carol Thomsen		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	Licensing Program Analyst (LPA), Cindy Interiano, conducted an Annual/Random inspection and met with Director, Carol Thomsen. Purpose of the inspection was explained. Program operates M-F, 7:30a-5:30p, year-round with periodic breaks throughout the year. Present during the inspection was Director and 6 Staff supervising 19 PreK children. Program is in compliance with Staff: child ratios. All staff have criminal record clearance. LPA and Director inspected facility indoors and outdoors for Health and Safety hazards. Program operates in one large classroom. Kitchen and Staff restroom are maintained off limit to children. Classroom has age appropriate toys and equipment. Napping equipment is properly stored. Cubbies and hooks are used to store children’s belongings. Classroom is equipped with a restroom with 2 toilets and 2 sinks. Restroom is kept clean, in good repair, and with adequate supplies. Cleaning supplies and toxins are maintained off limits to children. Program uses food vendor ‘Chefables.’ Classroom has a fully supplied Emergency Kit and Emergency Supplies, which are maintained inaccessible to children. Classroom has a working telephone, smoke and carbon monoxide detector, and a fire extinguisher. Last emergency drill was conducted on 11/21/19 and is properly logged. Discipline policy is mainly redirection. Outdoor play area is completely fenced in and is kept free of debris and dangerous conditions. Sand box is covered daily. Staff conduct daily sweeps prior to the children going out for outdoor play. All outdoor toys and equipment are age appropriate and in good repair. Drinking water is readily available outdoors and indoors. All mandatory postings are posted near the main entrance of the facility. Sign in/out sheet was reviewed and was complete and up-to-date. Staff immunization are on file and are up-to-date. Discussed during the inspection was a future increase of capacity. LPA discussed what is needed for the process. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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: ALL FIVE @ BELLE HAVEN (PS)	FACILITY NUMBER: 414004132
	VISIT DATE: 12/17/2019

NARRATIVE

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Page 2. . .

Also during the inspection, Director and LPA discussed multiple reported incidents.
First incident occurred during various dates in which Child#1 was biting other children. Staff and Guardian#1 worked together in 'cooping' strategies for Child#1. Child#1 adjusted well to the changes and has since significantly reduced bitting incidents. Child#1 continues to attend the program.
Second reported incident occurred on 04/29/19, which involved Child #2 slipping from an outdoor play structure during a Field trip to a nearby park, and bumping the back of their head. First Aid was immediately administered and Child #1’s Guardian#2 was contacted. Child#1 was not taken to the doctor or hospital, however Child #1 recovered quickly and returned to the center.
A third incident occurred on 09/25/19, when the class went on a field trip to a nearby park. When it was time to return to the classroom, Child#3 was not ready to stop playing. Staff#1 encouraged Child#3 to walk with the group. Child#3 did not want to leave and seeing that the group was returning to the classroom, Staff#1 carried Child#3 back to the classroom. Guardian#3 was advised of the incident. Later that evening, Guardian#3 contacted Director, after noticing scratch marks on Child#3. Director apologized to Guardian#3 and reassured Guardian#3 that that will not happen again. Director spoke to Staff#1 and all Staff, letting them know that a child is to be 'guided' not carried.

Also during the inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Director was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Director was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com)
*Director was advised of the new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts
*Director was reminded about the Provider Information Notices (PINs) on CCLD website.

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Ch. 1. ***

>This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site inspection was posted.
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: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

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