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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004405
Report Date: 08/03/2022
Date Signed: 08/03/2022 03:34:58 PM


Document Has Been Signed on 08/03/2022 03:34 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:LOS LISTOS PRESCHOOLFACILITY NUMBER:
414004405
ADMINISTRATOR:SEGURA, ROSALVAFACILITY TYPE:
850
ADDRESS:490 MIRAMONTE AVE.TELEPHONE:
(650) 240-3233
CITY:HALF MOON BAYSTATE: CAZIP CODE:
94019
CAPACITY:15CENSUS: 0DATE:
08/03/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director, Rosalva Segura and Graciela KrabbenschmidtTIME COMPLETED:
01:00 PM
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On August 3rd, 2022 at approximately 10am, Licensing Program Analyst (LPA) Tapia-Mandujano met with Director, Rosalva Sugura and Graciela Krabbenschmidt for a Scheduled Case Management. Facility operates their preschool program at the Cabrillo Unified School District campus.

Facility has requested to do a room change and to increase capacity from 15 to 40 preschool children (ages 3-5yrs old). Fire Clearance was received by Coastside Fire Disctrict on June 21st, 2022. The facility will operate Monday - Friday; 8:00 AM- 11:30 AM. Portable K6 will be shared with TK elementary after school children from 2pm-6pm after facility is no longer operating. The designated director for the facility is Rosalva Segura. Children are in summer break and first day of school will be August 11th, 2022. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: Facility was previously licensed at portable "Los Listos Preschool" and has now moved to Portables K5 and K6. Portables K5 and K6 have measured for Total useable indoor square footage is 2,560.621 sq ft exceeding the desired capacity of 40. There is three bathrooms in the facility that is equipped with one toilet and one sink, and an additional sink in the classroom, for a total of three toilets and five sinks available to children. One of the restrooms is inside of Portable K4, facility has posting on door for exclusive use of Los Listos Preschool. Sinks with water that are accessible to children do not deliver hot water. There are separate bathrooms for staff usage.

The indoor space for children is observed by LPA, there is furnishings, toys and equipment for children and staff use that are clean and appropriate for use. There is storage space for children's personal belongings, napping will not be offered due to being a part time program. Provisions will be made in the event a child needs to sleep. Children will be signed in and out manually. Each classroom is equipped with a fire extinguisher, smoke and carbon monoxide detectors, and first aid kit. There is a kitchen area within the school. Facility provides lunch for children that are prepacked, and children will bring their own snacks. Garbage cans have tight-fitting lids. The facility is adequately ventilated and free of insects and bugs. Cleaning products or other hazards will be stored separately. Medications will be stored in the classrooms inaccessible to the children; there will be a refrigerator for refrigerated medications. Isolation of ill children will be in the classrooms cozy area. For drinking water children will bring their own individual water bottles to the facility each day, and will be allowed to have free access to water at any time. There is a filtered water dispenser in each classroom.

Outdoor: The outdoor area measures 8,825.94.1 square feet exceeding the desired capacity for 40 children. The yard is clean and all equipment appears to be in good condition. Outdoor area is fenced by at least a four foot gate all around. There is sufficient cushioning underneath the play structure. For access to drinking water, children will be bringing out their personal water bottles. Outdoor area provides shading for children.

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SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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 2


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: LOS LISTOS PRESCHOOL
FACILITY NUMBER: 414004405
VISIT DATE: 08/03/2022
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The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation-none provided, Parents Rights, and Reporting Requirements. Required postings were observed during today's inspection. Facility will conduct disaster drills every 6 months and a log will be maintained for review upon request.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

APPLICANT WILL WAIT TO DETERMINE IF THEY WILL PROVIDE IMS:
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant, LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA will approve the room change for Portables K5 and K6 and increase capacity from 15 to 40 preschool age children as of today, August 3rd, 2022.

Exit interview conducted and report was reviewed with Director, Rosalva Segura and Graciela Krabbenschmidt.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC809 (FAS) - (06/04)
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