414004599-10-1-2020-05-CC-GASL-BTYQNH-20201001121910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004599
Report Date: 05/07/2020
Date Signed: 10/01/2020 12:20:42 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:	ODYSSEY PRESCHOOL		FACILITY NUMBER:	414004599
ADMINISTRATOR:	JIANG, DAN		FACILITY TYPE:	850
ADDRESS:	590 MYRTLE STREET		TELEPHONE:	(650) 678-1842
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94062
CAPACITY:	24	CENSUS: 0	DATE:	05/07/2020
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ratna Sanjay		TIME COMPLETED:	12:15 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	Licensing Program Analyst (LPA) Glenn Schnell conducted an office meeting today at 11 am via telephone to discuss the pending corrections/revisions needed following a review of the Application A and B documents that were originally submitted, as well as to review and discuss the first round of corrections/revisions received from the Applicant. LPA Schnell also reviewed the list of items identified on the pre-licensing inspection report dated 7/25/2019. The meeting is being conducted by telephone due to the current COVID-19 health crisis and local County and State orders that details social distancing guidelines and best practices during this period. Based on the review today, the following items were determined to be necessary to submit to Community Care Licensing to complete the application process. A license to operate will not be issued until the following corrections/revisions have been received, reviewed and verified: -Fire Clearance must be received -Financial Verification from the Applicant's bank must be received -Acknowledgement to Report, Suspected Child Abuse (LIC 9108) forms must be completed by the Applicant and Director -Applicant must take online orientation components 1 and 3; Application and Regulations and record keeping. Report continues on the next page

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2020

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: ODYSSEY PRESCHOOL	FACILITY NUMBER: 414004599
	VISIT DATE: 05/07/2020

NARRATIVE

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-A corrected Monthly Operating Statement must be received. Line 3 list total capacity requested; Line 4 list your tuition rate; lines 28-33 are zero, please provide an explanation in writing for this; Line 17 needs to be at least 25% of line 16.
-An updated Personnel Report (LIC 500) needs to be submitted. The original is from almost a year ago. Also staffing must reflect enough coverage from open to close. From 4:30 PM to 6 PM you identify one staff person at the facility, but you are applying for a capacity of 24. Add additional staffing or staffing hours to show adequate staffing based on 24 children.
-LIC 503 (Health Screening/TB) and immunization's for MMR, TDap and Influenza needed for the Applicant and Director. Must have originals with original signatures. Must be no older than 1 year from date of application. Submit documents or proof of a verifiable appointment if there are delays with meeting this requirement due the COVID-19 health crisis(appointment card/letter from doctor is considered verifiable)
-LIC 9148 (Earthquake Preparedness Checklist) You must fill out this form placing check marks next to items you have completed. Submit form to Licensing, keep a copy to post in your facility.
-LIC 999 Facility Sketch. As indicated earlier, sketch needs to show emergency exists and utility shut off locations. Major equipment also needs to be identified if any; toilets and sinks need to be identified and a sketch of the entire facility on one form needs to be included to show the relationship of the indoor space to the outdoor space.
-Need a copy of the corporation Bylaws. Only Articles of Incorporation were submitted.
-Applicant and Director need to complete online mandated reporter training. Training submitted is outdated, older than 2 years.
-Director needs to complete and submit verification of 8 hours preventative health practices (EMSA certified) needs to be completed.

Report continues on the next page

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2020

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: ODYSSEY PRESCHOOL	FACILITY NUMBER: 414004599
	VISIT DATE: 05/07/2020

NARRATIVE

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-The exception request for the Director ECE Administration Units needs to include proof that the Director is enrolled in a current or upcoming class. The current request indicated the Director would complete this by end of 2019, if class is completed, send transcript to Licensing for verification.
-Job Descriptions- What was submitted is not meeting the requirements. For each position, clearly stated the lines of supervision for each position; for the director- who supervises them and who do they supervise; for the Teacher- who supervises them and who do they supervise. This is not clearly stated. Also, the minimum educational and experience requirements for each position need to be clearly indicated and must match what is stated in the regulations. For example, you cannot simply state a degree and experience is required. You need to indicate the total semester hours and each core class, and indicate specifically how much experience is required for each position as it states in the Regulations. What is currently stated does not meet the minimum. And since you are a Montessori program, each position should indicate if you require Montessori certificates from schools accredited to provide the training/education. And must indicate that they certificate must clearly show the completion of the required core units.
-Personnel Policies- The Polices submitted need to indicate the work hours and shifts that are offered as part of employment. Also describe your hiring practices; the specific requirements to obtain employment: list all of the Licensing documents (LIC forms) required for completion, including training's like Mandated Reporter Training, 16 hours Preventative Health Practices, pesticides training for the director. Include the completion of the Live Scan form and background check process. These are all necessary at a minimum for Licensing standards.
-Parent Handbook- The handbook is missing these items: List days and hours of operation, list the ages of the children accepted (2 years to entry into first grade), Indicate what you do for field trips and transportation. If you provide or offer neither, the handbook must state this. Your parent handbook needs to state what you do for medical and dental emergencies.

Report continues on the next page

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2020

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: ODYSSEY PRESCHOOL	FACILITY NUMBER: 414004599
	VISIT DATE: 05/07/2020

NARRATIVE

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-An Incidental Medical Services Policy needs to be developed since your handbook indicates you will care for children with these medical needs. Applicant will be given a sample of an IMS plan when this report is emailed to them for signature.
-Discipline Policies need to include types of discipline not permitted, state that no corporal punishment is allowed, state what the grounds for dismissal are as it relates to discipline, and what you do to involve parents when handling disciplinary issues of children that are ongoing.
-Admissions Policies need to stated the persons accepted for care (example children ages 2 to entry into first grade, potty trained, not potty trained, etc...); State what your pre-admission appraisal process is and what your criteria is for determining program appropriateness for children enrolling in the program. Your admissions policies must also list all of the requirements needed for enrollment, including all of the Licensing forms required, listing each Licensing form and title as well as the immunization record and any other records or reports you require as part of admission. You can add these details to page 5 of the Parent Handbook. What you have submitted is not meeting the requirement.
-Admission Agreement. The admission agreement must contain very specific items. The Admission Agreement submitted is missing; a description of basic services offered; Modification conditions- 30 day notice to parents required, Licensing Agency Rights, Payment provisions/rates/due date/frequency; indicate if optional services are offered; Reasons for termination of the agreement; and the agreement must contain signature and date lines for the parent(s) and a facility representative.
-List of Furniture and Play Equipment; the list must contain details of toy and activities for children so we can verify age appropriateness

Report continues on the next page

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: ODYSSEY PRESCHOOL	FACILITY NUMBER: 414004599
	VISIT DATE: 05/07/2020

NARRATIVE

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These are additional Items as listed on the pre-licensing inspection report dated 7/25/2019 that need to be completed as well:

-Facility requires a phone.
-Child proof locks required for cabinet where toxins will be stored.
-Staff bathroom needs a sign.
-Garbage cans required for the bathroom.
-Smoke detectors are not operable and need to be repaired or replaced.
-Carbon monoxide detector.
-Outdoor area requires cleaning.
-Postings are incomplete. Daily activity schedule & earthquake preparedness are required to be posted and completed.

Applicant agreed today to provide verification of completion of all corrections/revisions identified on this report no later than 6/8/2020. Applicant understands that failure to meet the requirements as outlined in this report will result in the denial of this application.

A copy of this report was emailed to the applicant. The applicant is being asked to sign the report and scan a copy back to LPA no later than close of business day 5/8/20.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2020

LIC809 (FAS) - (06/04)

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