414004457-5-24-2019-05-CC-AMEN-BCGSC8-20190524134507

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004457
Report Date: 05/24/2019
Date Signed: 05/24/2019 01:45:11 PM

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:	2ND GENERATION CABOT (SA)		FACILITY NUMBER:	414004457
ADMINISTRATOR:	ALCANTARA, RACHYL		FACILITY TYPE:	840
ADDRESS:	342 ALLERTON AVE		TELEPHONE:	(650) 225-3666
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	40	CENSUS: 0	DATE:	05/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Rachyl Alcantara		TIME COMPLETED:	01:50 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	Licensing Program Analyst (LPA) Andrea Medlin met with director for this random annual licensing visit. Purpose of visit explained. There are no children present as program is not in operation at this time. Physical plant toured, including the classroom used for the program, and outdoor play areas to inspect for health and safety hazards. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. There are staff bathrooms present. No pools, spas, hot tubs, fish ponds, or bodies of water are present. Per director, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available in the classrooms. Facility provides all meals and snacks. First aid supplies are available. Sick children will be separated from the group and wait for parents to pick up. There are school aged outdoor play areas. Outdoor activity space surfaces are free of hazards. Facility has posted all the required licensing forms (License, Notification of Parent's Rights, Notification of Personal Rights, Earthquake preparedness checklist, and Emergency Disaster Plan). LPA reviewed staff files. Staff have current Pediatric First Aid and CPR certification, documentation of the appropriate educational requirements; verification of the required staff immunizations or proof of immunity, and verification of the mandated child abuse reporting training as compliant with AB1207. (Continued on next page 809-C)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: 2ND GENERATION CABOT (SA)	FACILITY NUMBER: 414004457
	VISIT DATE: 05/24/2019

NARRATIVE

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Incidental Medical Services (IMS) policy discussed. Facility has IMS on file. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA is 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. Facility informed that effective 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. LPA reviewed with director the Mandated Child Abuse Reporting training as compliant with AB 1207. As of January 1, 2018 all child care staff and volunteers are required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

This report is reviewed with director and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019

LIC809 (FAS) - (06/04)

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