414004138-5-10-2023-05-CC-CQUO-CRPNGP-20230510102727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004138
Report Date: 05/10/2023
Date Signed: 05/10/2023 10:27:36 AM

Document Has Been Signed on 05/10/2023 10:27 AM - 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	THOMAS EDISON ELEMENTARY SCHOOL		FACILITY NUMBER:	414004138
ADMINISTRATOR:	ZIMIGA, LISA		FACILITY TYPE:	850
ADDRESS:	1267 SOUTHGATE AVENUE		TELEPHONE:	(650) 991-1250
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	24	CENSUS: 18	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Geraldine Malunay		TIME COMPLETED:	10:45 AM

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 May 10, 2023 at approximately 8:15am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with site supervisor, Geraldine Malunay, and explained the purpose of the inspection. Hours of operation are Monday through Friday 8:15am to 2:45pm. Preschool program operates at Thomas Edison Elementary in KB classroom only. Present during LPA's visit included site supervisor, 2 teaching staff, 1 RBT specialist and 18 preschool children. Per site supervisor, RBT specialist does not work with all children but works with one child specifically for 3 hours a day. All staff are fingerprinted through Jefferson Elementary school district. Program is operating within capacity limits and ratio during LPA's visit. With site supervisor, LPA inspected classroom, indoors and outdoors, for health and safety hazards. LPA observed preschool classroom to be clean and properly ventilated. Classroom is sectioned into multiple areas that include dramatic play, writing, science, math, building, arts and crafts and a library area. LPA observed each section to be clean, free from any hazards or poisons. Storage for children's belongings are located inside a large cabinet in the classroom, labeled with each child's individual names. LPA observed poisons, cleaning supplies and other hazardous materials to be stored inaccessible to children, in classroom's high shelves and/or cabinets. Classroom is equipped with a first aid kit, fire extinguisher, working telephone and fire alarm system that is implemented by school district. Per site supervisor, classroom is also equipped with a smoke and carbon monoxide detector that is hardwired in classroom through school district. Preschool classroom includes a bathroom that is exclusive for preschool program. LPA observed bathroom to be in proper working condition, equipped with appropriate toileting equipment. Sinks children have access to do not provide water that is warmer than 120 degrees Fahrenheit. LPA observed sinks to be equipped with appropriate sanitation products. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: THOMAS EDISON ELEMENTARY SCHOOL	FACILITY NUMBER: 414004138
	VISIT DATE: 05/10/2023

NARRATIVE

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Outdoor area is entirely enclosed with an at least 4 ft. high fence. Per site supervisor, outdoor area is shared with 2 other programs. LPA observed outdoor waiver to be properly maintained and posted. Outdoor area is equipped with a variety of outdoor toys and materials that were in good working condition. There is a play structure that has resilient padding underneath. Water is made available to children both indoors and outdoors with a refillable pitcher and children's water cups that are labeled with each child's names.

Children are signed in and out of facility by parents' written signatures. LPA observed children to be properly signed in on date of LPA's visit. Facility has license documentation and information properly posted and available for review near front entrance of classroom.

LPA reviewed facility records that included six children's records, which were complete. Children's files have record of emergency identification information on file and required immunizations. Last emergency disaster drill was conducted with entire school 03/09/2023. Per site supervisor, next scheduled disaster drill will be conducted 05/12/2023. Site supervisor's CPR/First Aid certification is current and will expire 04/2024.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Site supervisor is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: THOMAS EDISON ELEMENTARY SCHOOL	FACILITY NUMBER: 414004138
	VISIT DATE: 05/10/2023

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Site supervisor 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 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.

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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No deficiencies were issued under CCR, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with site supervisor, Geraldine Malunay.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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