414004406-3-13-2025-05-CC-JGIL-DEQPTP-20250313113615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004406
Report Date: 03/13/2025
Date Signed: 03/13/2025 11:36:33 AM

Document Has Been Signed on 03/13/2025 11:36 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	BAYSHORE ELEMENTARY SCHOOL DISTRICT		FACILITY NUMBER:	414004406
ADMINISTRATOR/ DIRECTOR:	YEARGIN, KHANH		FACILITY TYPE:	850
ADDRESS:	155 ORIENTE STREET		TELEPHONE:	(415) 467-5443
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94014
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 8	DATE:	03/13/2025
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:09 AM
MET WITH:	Merlita Sabado		TIME VISIT/ INSPECTION COMPLETED:	12:30 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 March 13th, 2025 at approximately 9:00 AM, Licensing Program Analyst (LPA) Gil conducted an unannounced, annual inspection. LPA met with site supervisor, Merlita Sabado, and explained the purpose of the inspection. Hours of operation are Monday to Friday 8:15 AM to 3:15 PM. Per site supervisor, facility has two part time groups of enrolled preschoolers. The first group attends from 8:15 AM to 11:15 AM, while the second group attends from 12:15 PM to 3:15 PM. Facility operates from Bayshore Elementary School District from classroom #101 only. Present during inspection included 8 children with 4 staff members (including site supervisor). All staff are fingerprinted through Bayshore Elementary School District. Facility is operating within capacity requirements and ratios at time of LPA's inspection. LPA inspected classroom #101 and designated outdoor area for health and safety hazards. LPA observed classroom to be clean, equipped with age appropriate toys, materials, and furniture. LPA observed electrical outlets to be made inaccessible with outlet covers and furniture. LPA also observed a covered trash can. Storage for children's belongings are located inside the classroom, labeled with each child's individual names. Per site supervisor, program operates as two part time programs, and no designated nap time is provided. Site supervisor stated there is one enrolled child(C1) with a fish allergy. Epi pen is kept at front desk with office staff. Office staff is parent of C1. Per site supervisor, 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. Classroom has a fully stocked and accessible first aid kit backpack near the exit door. Facility has a fire extinguisher located inside the classroom. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children on facility's high shelves. LPA observed children's bathroom to be clean and in proper working condition. Facility provides snack only. Menus are posted outside the classroom. Water is available to children indoors and outdoors with children's water bottles. Per teacher in classroom, if a child forgets water bottle, they have plastic cups available. Continue on Page 2...

Garfield Leung	TELEPHONE: (650) 266-8800
Janet Gil	TELEPHONE: 650-266-8800
	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BAYSHORE ELEMENTARY SCHOOL DISTRICT	FACILITY NUMBER: 414004406
	VISIT DATE: 03/13/2025

NARRATIVE

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Preschool program includes an outdoor area that is shared with school district programs. Outdoor area is located outside preschool classroom. Outdoor waiver is properly posted outside school district's main office, available for review. Outdoor area is fully enclosed and has age appropriate toys and materials that were in working condition. LPA observed play structure to contain turf grass underneath. Per site supervisor, outdoor area is age appropriate for enrolled children.

Children are signed in and out of facility through an individual paper system by the front entrance of the classroom. All children were signed in correctly during LPA's visit. Facility has license documentation and information properly posted and available for review in main entrance of the school district's main office. Facility conducts drills every month. Last conducted disaster drill was on 02/12/2025.

LPA reviewed 5 children's files and 3 staff files. Children's and staff files were complete with a record of emergency identification information on file. All teachers have a valid CPR/First Aid certification. All staff also have proof of required immunization that were made available for review. Mandated Reporter Training Certification is done annually with the the school district.

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. LPA observed the completed certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BAYSHORE ELEMENTARY SCHOOL DISTRICT	FACILITY NUMBER: 414004406
	VISIT DATE: 03/13/2025

NARRATIVE

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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.

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

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.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Per site supervisor, school district building was built in 2017.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

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

Exit interview conducted and report was reviewed with site supervisor, Merlita Sabado.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

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