414004686-8-12-2020-05-CC-GASL-BSF2UY-20200812174303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004686
Report Date: 08/12/2020
Date Signed: 08/12/2020 05:43:20 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:	IHSD LAKEWOOD CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	414004686
ADMINISTRATOR:	GHEITH, KIFAH		FACILITY TYPE:	850
ADDRESS:	69 TOWER ROAD		TELEPHONE:	(650) 555-1234
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY:	24	CENSUS: 0	DATE:	08/12/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jennifer Pifeleti		TIME COMPLETED:	11:00 AM

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 met with IHSD Director of Operations, Jennifer Pifeleti, today for a pre-licensing inspection. The applicant has requested a capacity of 24 children ages 2 years to through 5 years old. The facility will operate Monday - Friday from 8:00 AM to 4:00 PM. There is already a licensed child care center operated by this same applicant/licensee located at 65 Tower Road, which is leased to the licensee by the County of San Mateo. The building located at 69 Tower Road is also San Mateo County property that will be leased to the applicant/licensee. The designated director/site supervisor for the facility is Kifah Gheith. Since 65 Tower Road and 69 Tower Road are located on the same campus of County owned property, Kifah will be the site supervisor for both locations. The facility was inspected today for health and safety hazards and measured to calculate capacity. Indoor: The indoor space to be used for child care will be "care room #2" as stated on the facility sketch provided. The total indoor square footage of useable space for the children is 933.19 square feet for a capacity of 26 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, a kitchen with a refrigerator, microwave and sink,there is a bathroom for children's usage that is equipped with a total of 2 toilets and 4 sinks. The bathroom is observed to be clean and with no health and safety hazards. Sinks accessible to children do not deliver hot water. Total allowable capacity for toilets is 30 and sinks is 60. 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: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

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: IHSD LAKEWOOD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004686
	VISIT DATE: 08/12/2020

NARRATIVE

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There is an indoor water fountain for children to drink water indoors. All toxins and other hazardous items will be stored in a locked cabinet in the classroom and will be inaccessible to children. Isolation of ill children will be located either in a corner of the classroom or the director’s office in the classroom and staff bathroom will be used for the ill child.

Outdoor: The outdoor area measures 5502.814 square feet allowing for a total of 73 children. The outdoor area is observed to be clean, safe and equipped with toys and equipment for children. Resilient material located under climbing applicable climbing structures is a soft spongy type material. There will be cups and water pitchers to provide drinking water to children. Shade for children is provided by the building awning.

There is no food preparation at the facility; snacks and lunch will be provided by a catering service. The facility will offer a morning breakfast/snack, lunch and an afternoon snack. The facility will only utilize disposable single use paper products and disposable utensils when providing food to the children.
The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements-cots will be used for napping, Food Service-catered in, Transportation-none provided, Parents Rights, and Reporting Requirements. The facility will conduct monthly disaster drills and a log will be maintained for review upon request. The fire inspection was conducted, and approval was received on 3/17/20. Covid postings were observed.

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: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

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: IHSD LAKEWOOD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004686
	VISIT DATE: 08/12/2020

NARRATIVE

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This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

An electronic copy of this report was emailed to the applicant and a request to review and sign this report was made.

LPA Schnell will recommend licensure for 24 children effective 8/12/20 once a signed copy of this report (3 pages) is returned by the applicant.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3