414004406-10-4-2023-05-CC-CQUO-CWARQN-20231004131350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004406
Report Date: 10/04/2023
Date Signed: 10/04/2023 01:13:57 PM

Document Has Been Signed on 10/04/2023 01:13 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	BAYSHORE ELEMENTARY SCHOOL DISTRICT		FACILITY NUMBER:	414004406
ADMINISTRATOR:	YEARGIN, KHANH		FACILITY TYPE:	850
ADDRESS:	155 ORIENTE STREET		TELEPHONE:	(415) 467-5443
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY:	30	CENSUS: 8	DATE:	10/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Merl Sabado & Ashley Atkins		TIME COMPLETED:	01:15 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	On October 4, 2023 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with site supervisor, Murl Sabado, and head teacher, T1, and explained the purpose of the inspection. Present in preschool program included 2 teaching staff (T1 and T2) and 8 enrolled preschool children. Preschool program is operating within capacity limits and ratio during LPA's visit. Preschool program operates in Bayshore Elementary School District in Classroom #101 only. Preschool program operates in two part time sessions with a morning and afternoon session. Morning session operates from 8:15am to 11:15am. Afternoon session operates from 12:15pm to 3:15pm. All staff are fingerprinted through Bayshore Elementary school district. During LPA's visit, children enrolled in TK program with TK teaching staff are also utilizing preschool program classroom. Per site supervisor, TK program children remain in preschool program classroom for the morning session. TK program children transition to a separate classroom for the afternoon session as needed. LPA inspected Classroom #101 and preschool outdoor area for health and safety hazards. LPA observed preschool program classroom to be clean and properly ventilated. Classroom is sectioned into multiple areas that include dramatic play, writing, art, and a reading area. LPA observed each section to be clean, free from any hazards or poisons. Storage for children's belongings are located inside the classroom, labeled with each child's individual names. Due to program being part time sessions, there is no napping period. Classroom is equipped with a working telephone, fire extinguisher, fire sprinklers and a fire alarm system that is implemented by school district. Per T1, classroom is also equipped with a smoke and carbon monoxide detector that is implemented through school district, in classroom's high ceilings. LPA was unable to test carbon monoxide detector during visit, but observed detectors in high ceilings. Preschool classroom includes a bathroom that was observed to be in working condition. LPA observed bathroom to be 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: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BAYSHORE ELEMENTARY SCHOOL DISTRICT	FACILITY NUMBER: 414004406
	VISIT DATE: 10/04/2023

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

(Continued, Page 2...)
Preschool program includes an outdoor area that is shared with school district's TK and Kindergarten programs. Outdoor area is located directly outside preschool classroom and is entirely enclosed and fenced, separate from elementary school district's outdoor area. Outdoor waiver is properly posted outside school district's main office, available for review.

Outdoor area is equipped with a variety of outdoor toys and materials that were in good condition. There is a play structure that has resilient padding underneath with wood chips. Water is made available to children both indoors and outdoors with children's individual water bottles. Per T1, children also have access to disposable cups that can be filled from water in classroom sink.

Preschool program children are signed in and out of program by parents' written signatures. Facility has license documentation and information posted and available for review outside of preschool program's classroom and outside school district's main office.
LPA reviewed facility records that included six children's records, which were complete. Children's files have a record required licensing documentation with emergency identification information and required immunizations. LPA reviewed preschool teaching staff files as well. LPA did not observe preschool teaching staff present to have a current CPR/First Aid certification.

Site supervisor 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.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BAYSHORE ELEMENTARY SCHOOL DISTRICT	FACILITY NUMBER: 414004406
	VISIT DATE: 10/04/2023

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

(Continued, Page 3...)
Facility representative was reminded that all adults 18 and over, including
employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

Per site supervisor and T1, school district building was built in 2017. LPA reminded site supervisor to submit documentation of when building was built to department.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

Facility representative was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Facility was cited a Type B citation for preschool teaching staff not having a current CPR/First Aid certification. Appeal Rights were provided and a plan of correction was discussed.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Merl Sabado.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 10/04/2023 01:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BAYSHORE ELEMENTARY SCHOOL DISTRICT	FACILITY NUMBER: 414004406
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above. Preschool teaching staff present do not have a current CPR/First Aid certification which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/06/2023
	Plan of Correction
1 2 3 4	Site supervisor will ensure that preschool teaching staff (T1 and T2) have a renewed CPR/First Aid certification that is Emergency Medical Services Authority (EMSA) certified. Proof of renewed certifications will be submitted to LPA no later than November 6, 2023 by 5:00pm.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4