<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004406
Report Date: 09/16/2021
Date Signed: 09/16/2021 11:30:51 AM

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:BAYSHORE ELEMENTARY SCHOOL DISTRICTFACILITY NUMBER:
414004406
ADMINISTRATOR:YEARGIN, KHANHFACILITY TYPE:
850
ADDRESS:155 ORIENTE STREETTELEPHONE:
(415) 467-5443
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY:30CENSUS: 15DATE:
09/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Maya BakerTIME COMPLETED:
11:00 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
Licensing Program Analyst (LPA) Kaur conducted an unannounced required inspection today. LPA met with the Director /principal, Maya Baker. The purpose of the inspection was explained. There were 15 children with 3 staff upon LPA arrival. The preschool program is run in Room # 101 at the Bayshore Elementary School. The preschool program has AM and PM sessions. The facility operation hours are Monday to Friday from 8:15am to 11:15am; PM session from 12:15pm to 3:15pm. The program was granted with the Outdoor Playground Waiver to share the playground with the elementary students by schedule. LPA informed the new director Maya Baker submit the required Director paperwork and qualifications to Licensing.

LPA inspected facility with Site Director. There are no bodies of water, firearms, or weapons on the premises. The school is in good repair with proper temperature and ventilation and is free of any hazards. All furniture is in good condition. Classrooms have age appropriate toys and equipment. Outdoor play area is fenced for supervision. Outdoor toys and equipment are age appropriate and in good condition. Play structures are age appropriate and in good repair.

All required postings are properly posted next to the entrance of the center. Children bring their own morning snack. Children also bring their own reusable water bottles and staff refill them throughout the day. All cleaning products and toxins are inaccessible to children. LPA reviewed children and staff records. Five children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff have a criminal record clearance on file.

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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: BAYSHORE ELEMENTARY SCHOOL DISTRICT
FACILITY NUMBER: 414004406
VISIT DATE: 09/16/2021
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
26
27
28
29
30
31
32
Emergency fire drill conducted on September 2nd 2021. The school has a complete record of sign-in/out sheets by authorized pickup person. There is a functional fire alarm system, a working fire and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone is available on-site. School phone number is (415)467-5433. Incidental Medical Services (IMS) was discussed. School currently has no children who need services this school year.

During inspection, Site Director was given updated state and county COVID-19 guidance and PIN 21-21-CCP and forms LIC 9275 and LIC 9276 regarding water lead testing written directives for child care centers. Site Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.622.Site Director was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at
www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available and filed in staff record. Site Director was reminded about the Provider Information Notices (PINs) on CCLD website. Site Director was advised for any additional questions to contact CCLD office, Monday to Friday, 8:00 am - 5:00 pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the teacher, Ashley Atkinson. Today's report, 9/16/2021, and notice of site visit will be sent to the facility Director by email at Mbaker@thebayshoreschool.org by the close of business on 9/16/21. Confirmation of receipt is required. LPA informed the Site Coordinator that the notice of site visit must be posted for 30 days.

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran KaurTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2