414004686-8-13-2021-05-CC-LGOZ-C5UV88-20210813161219

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004686
Report Date: 08/13/2021
Date Signed: 08/13/2021 04:13:40 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) 504-9928
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY:	24	CENSUS: 0	DATE:	08/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Director, Kifah Gheith		TIME COMPLETED:	04:20 PM

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On 8/13/2021 at 1:05P.M. Licensing Program Analyst, (LPA) Luis J. Gomez met with Director, Kifah Gheith at the facility. Purpose of inspection was explained and was an unannounced annual inspection. Per director, the preschool site is closed today. Preschool program at 69 Tower Road utilizes one classroom: Room #2 ( 2- 3 years olds) and one outdoor play area. Hours of operation are Monday- Friday 8:00am- 4:00pm. Childcare program operates year around. Present during inspection was the Director, four staff and no children. LPA inspected facility with Director for health and safety hazards.

At 1:15A.M., LPA inspected classroom #2 and observed the following: Classroom was clean and had a variety age appropriate toys, blocks and books for the children. All playthings and furniture inspected were in good repair. Classroom had been divided into two separate play areas. Classroom had several child sized tables and chairs for snack and activities. Sharp edges have been covered with soft padding. Floor surfaces were observed to be safe and clean. Cubbies were located in the entry way for added storage. Stackable napping cots were available and stored in the classroom. Per director, the napping linins are washed daily. Children’s bathroom is maintained clean with adequate supplies for the children. Bathroom was equipment with diaper changing table and drawers for added storage. Facility staff shares off site bathroom, which is located in the hallway. Indoor and outdoor passageways were free of potential hazards and obstructions. All trash bins and outlets have been properly covered. Off-limit areas were made inaccessible with child safety gates. All accessible cabinets had safety locks installed. Classroom had acceptable ventilation and natural lighting. Facility had a smoke/ carbon monoxide detector combo and a fully charged fire extinguishers (3A:40BC). First aid kit was fully stocked. All required forms are properly posted including: Updated Menu, Parent’s Rights (PUB 393), Emergency Disaster Plan (LIC610) and Facility License. Food preparation area had a refrigerator, food heating unit and soap for staff. Preparation area was clean and free of litter and rubbish.

At 1:40A.M., LPA inspected the outdoor play area. Outdoor play area was completely enclosed with fencing at least 4 feet high. Play swings and climbing equipment had been properly anchored and was free of debris. For accessible water, facility uses disposable cup and large water jugs. Per director, water jug are refilled daily. Sandbox was made inaccessible and had been covered. Large shaded rest areas are accessible to children. Outdoor playthings were in good repair. (REFER TO 809-C, FOR CONT.)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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: IHSD LAKEWOOD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004686
	VISIT DATE: 08/13/2021

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At 2:40P.M., LPA reviewed a sample of the facility records. CPR/ 1^st aid certification is current expiring: 8/11/2022. Facility is documenting and conducting required emergency disaster drills, with the last drill done on 7/2/2021 and is properly logged.

Incidental Medical Services (IMS) was discussed. Per director, facility has no children who require IMS services at this time. The following information regarding Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During inspection,

· Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· Director was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
· Director was reminded about the Provider Information Notices (PINs) on CCLD website.
·LPA reviewed facility’s COVID-19 guidance including: Child In-take procedure, Mask wearing, Regular disinfecting of high surfaces and reporting requirements.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was conducted with Director, Kifah Gheith and her signature of this form acknowledges receipt of these documents.

>This report and rights to comment were discussed. This report must be available in the facility for public review. Notice of site inspection was posted. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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