414004670-7-14-2021-05-CC-BVAN-C4WQW3-20210714123116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004670
Report Date: 07/14/2021
Date Signed: 07/14/2021 12:32:53 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:	PALCARE (TIDEPOOLS)		FACILITY NUMBER:	414004670
ADMINISTRATOR:	KIESSELBACH, LISA		FACILITY TYPE:	830
ADDRESS:	1001 CALIFORNIA DRIVE		TELEPHONE:	(650) 787-5477
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY:	32	CENSUS: 10	DATE:	07/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Lisa Kiesselbach		TIME COMPLETED:	12:45 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 July 14, 2021, at 9:45 AM, Licensing Program Analyst Van conducted an unannounced annual inspection and met with the Director, Lisa Kiesselbach. The purpose of the inspection was explained, and was granted entry to the facility by the staff. This is an infant program that operates in 3 classrooms (play areas 1, 2, and 4) and a circulation area. The operation hours are Monday to Friday from 6:00 AM to 7:00 PM. In today's inspection, there were five teachers and an aid supervising ten infants. LPA observed that the facility has an electronic sign-in / out for parents or authorized representatives. LPA, along with the Director, inspected the center for health and safety hazards. The center is clean and orderly. Heating, lighting, and ventilation are adequate. There are no pools, spas, or other bodies of water on the premises. Per the Director, there are no firearms or weapons at the center. All cleaning supplies or other potentially harmful items are stored inaccessible to the children. The furniture and equipment are in good repair and are free from loose sharp, or pointed parts. All solid waste storage containers have tight-fitting lids. The facility has more than one carbon monoxide detector and smoke alarm installed. Classrooms are equipped with fully supplied First Aid. Outdoor play areas are in good repair and free of hazards. There are age-appropriate toys and learning materials available for children. LPA observed that the diaper changing tables have at least 1" thick padding covered with disposable paper and with sides raised to at least a minimum of 3". The changing tables are within arm's reach of the sink, and disposable wipes are used to clean after each use. There is a separate napping area for children to nap or rest without distraction or disturbance. There is sufficient sleeping equipment, cribs, and cots used and available for each child present. There is a staff present in a designated area visually observing children in the napping room. Mats and beddings are appropriately stored. LPA did not observe any walkers, bouncers, or other similar items in the daycare. Continued on the next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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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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: PALCARE (TIDEPOOLS)	FACILITY NUMBER: 414004670
	VISIT DATE: 07/14/2021

NARRATIVE

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This center provides Incidental Medical Service (IMS). LPA reviewed storage and paperwork requirements with the Director. LPA observed that the food prep area is clean and organized, with food stored appropriately. Director stated dishwasher is used daily for proper washing of dishes and utensils; infant bottles are returned to the parents daily for washing. Per the Director, Infant and Service Plan are conducted once every six months and are kept in the children's file.

LPA reviewed the staff's and children's records. A sample of children's files was checked and found to have medical assessments, needs, and services, feeding plans, and signed admission agreements. Staff files are organized, complete, and have documentation of education credits. Multiple staff members records have valid CPR cards in files and have immunization documentation for Measles, Pertussis, and Influenza. LPA also observed that the facility had posted the required forms. (i.e., License, menus, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). The Director stated that Fire and Earthquake drills are done once every other month; the last fire drill was logged on June 17, 2021. The facility currently has an outdoor waiver that approved eight children to use the outdoor at one time, and a rotational schedule is required.

LPA reviewed the Mandated Reporter Training AB 1207 and the General Training with the Director. As of January 1, 2018, all staff is required to complete Mandated Reporter Training AB 1207 every two years. The training can be obtained online at www.mandatedreporterca.com. Records review showed that all staff members completed the training.

LPA reminded the Director 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.

The Director was advised of the new Safe Sleep Regulations. Information on Safe Sleep can be accessed from ccld.ca.gov

The report was reviewed and signed by the Director, Lisa Kiesselbach. Today's report, 7/14/2021, and notice of site visit will be sent to the Director at lisa@palcare.org by the close of business on 7/14/21. Confirmation of receipt is required.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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