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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004546
Report Date: 12/07/2021
Date Signed: 12/07/2021 02:56:54 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:TERRA NOVA CHRISTIAN PRESCHOOLFACILITY NUMBER:
414004546
ADMINISTRATOR:TATIANA HILLMANFACILITY TYPE:
830
ADDRESS:1125 TERRA NOVA BLVD.TELEPHONE:
(650) 355-2962
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY:20CENSUS: 32DATE:
12/07/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Tatiana HillmanTIME COMPLETED:
03:10 PM
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On December 7, 2021 Licensing Program Analyst (LPA) Cowan conducted a case management inspection.This inspection is due to a call and email from site director requesting approval of new play structure. LPA met with site director to inspect new play structure for toddlers. Currently in the facility is director, 7 staff, and 32 children. LPA inspected the outdoor area. LPA observed new structure which is appropriate for use of ages 6 to 23 months according to specifications. Structure consist on one slide and three activity areas. Play structure has rubber matting to observe fall. Facility is using a portable gate to keep children in. LPA observed that the gate is not sturdy and is apt to collapse with little force. Site director states that the gate has been ordered but has not been delivered as of this date. LPA approves structure upon installation of a sturdy gate.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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