414004670-5-26-2022-05-CC-BVAN-CESQQG-20220526122218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004670
Report Date: 05/26/2022
Date Signed: 05/26/2022 12:23:11 PM

Document Has Been Signed on 05/26/2022 12:23 PM - It Cannot Be Edited

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: 6	DATE:	05/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lisa Kiesselbach		TIME 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	Licensing Program Analyst (LPA) Van met with Director Lisa Kiesselbach on May 26, 2022, for an unannounced mandatory 1-year random inspection. The facility is an infant program, serving infants from 3 – 24 months. Today, four teachers, including the Director, supervised six infants. Today's staff-to-infant ratios are met at the facility. The hours of operation are Monday through Friday, 6:00 am to 7:00 pm. The program is operated on a large open floor, partitioned into three pods. There is also a circulation area in a separate room next to the outdoor play. An unwell child is isolated in pod #3, and the staff will observe and supervise the child until parents are informed to come and pick them up. LPA assessed the Center for health and safety hazards with the Director. LPA observed that the facility has an electronic sign-in / out for parents or authorized representatives, and a pin code is provided to parents. The Center is clean and organized. There is ample heating, lighting, and ventilation. The facility has age-appropriate toys, furnishings, cribs, changing tables, and equipment. There were no pools, spas, or other bodies of water noticed by LPA. LPA observed no bouncers, exersaucers, or similar equipment at the Center. According to the Director, there are no firearms or weapons at the Center. All cleaning materials and possibly hazardous objects are kept out of reach of children. There are separate restrooms for the personnel. The lids of all solid waste storage containers are tightly fitted. There are multiple carbon monoxide detectors, a centralized smoke alarm, and a fully equipped First Aid kit at the facility. LPA observed four changing tables. The diaper changing tables have at least 1" thick padding, are covered with disposable paper, and have at least 3" elevated edges. The changing tables are within arm's reach of the sink, and disposable wipes are used to clean after each usage. There is a separate sleeping room where infants can nap or rest without being disturbed. There is sufficient sleeping equipment, cribs, and cots for each child. Mats and bedding are kept in the appropriate location. Parents' breast milk/formula is appropriately stored in the refrigerator, and each bottle is labeled. Parents provide their children with formula, food, and diapers. LPA noticed that the food preparation site is clean and organized and that children are not permitted.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: 05/26/2022

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
26
27
28
29
30
31
32

The facility presently has an outside waiver that allows for eight children to utilize the outdoor at the same time, and a rotating schedule is necessary. The outdoor infant play area is maintained clean and free of debris.
LPA checked personnel and children's records. A sample of children's files was evaluated and found to have medical assessments, needs, services, feeding plans, and signed admission agreements. Staff files are well-organized and thorough, including proof of educational credentials. Multiple staff members have valid CPR cards in their files and Measles, Pertussis, and Influenza vaccine proof. LPA also noticed that the facility had posted the required documents. (License, menus, waivers, Notification of Parental Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan.) The Director indicated that fire and earthquake drills are held every month, with the most recent fire drill taking place on 3/23/2022.
LPA discussed the safe sleep regulations with the Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
The incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
The Director 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.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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

FACILITY NAME: PALCARE (TIDEPOOLS)	FACILITY NUMBER: 414004670
	VISIT DATE: 05/26/2022

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
26
27
28
29
30
31
32

The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to complete every two years by the Licensee and all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
LPA encouraged the Director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Director can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
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/process.

LPA requested an up-to-date Emergency Disaster Plan (LIC 610), Personnel Report (LIC 500), and Incidental Medical Services (IMS) during the inspection to be sent to Licensing office by June 2, 2022.

No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Director, Lisa Kiesselbach. Today's report, May 26, 2022, and notice of site visit will be sent to the Director by email by the close of business on May 26, 2022. Confirmation of receipt is required. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3