414004701-10-6-2020-05-CC-GASL-BU66SZ-20201006210446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004701
Report Date: 08/27/2020
Date Signed: 10/06/2020 09:05:15 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:	AFTERSCHOOL CARE ENRICHMENT-AT MARIPOSA		FACILITY NUMBER:	414004701
ADMINISTRATOR:	SAUCEDO, J/DASKALAKIS, E		FACILITY TYPE:	840
ADDRESS:	750 DARTMOUTH AVENUE		TELEPHONE:	(650) 921-2948
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY:	60	CENSUS: 0	DATE:	08/27/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Eve Daskalakis		TIME COMPLETED:	05:00 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 met with Applicant, Eve Daskalaskis, today for a pre-licensing tele-inspection. The applicant is requesting 60 children (ages 5 years old to 13 years old) in rooms T and S. The facility is locate and at Mariposa Elementary School will operate Monday - Friday; 7:30 AM to 6:00 PM. The designated director/site supervisor for the facility is Jamie Saucedo. The facility was inspected today, indoor and outdoor, for health and safety hazards. Since the school age program is operated on a functioning elementary school site, the rooms can be used as elementary school classrooms, and the rooms will be leased by the school district, the program is exempt from outdoor square footage requirements, fencing requirements, toilet/sink ratios, isolation requirements and indoor square footage requirements. No measurements were taken; the applicant is in the process of obtaining a capacity letter from the school principal. The school age children will have use of the elementary school playground and outside bathrooms which provide individual privacy. Staff will escort children to and from the bathrooms located on the campus of the elementary school and will ensure the bathrooms are clean and safe prior to being used by any children. Indoor: The indoor spaces for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There is storage space for children's personal belongings located outside of the classrooms. The indoor space is equipped with a fire alarm system and carbon monoxide detectors, food prep/kitchen area (room T) with a sink/hot water, stove, refrigerator, microwave. Each room has garbage cans with tight-fitting lids, first aid and emergency supplies. Continued on 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: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

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: AFTERSCHOOL CARE ENRICHMENT-AT MARIPOSA	FACILITY NUMBER: 414004701
	VISIT DATE: 08/27/2020

NARRATIVE

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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- talking and redirection will be used, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Food Service, Transportation-none provided except field trips contracted transportation services will be used, Parents Rights, and Reporting Requirements. Applicant will ensure all required postings are posted and visible to parents.

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 8/10/2020.

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

At this time, applications for licensure and active licenses for licensed facilities on school campuses is currently under review. A license cannot be recommended at this time until the review process is complete and it is determined if there are additional requirements needing to be met by the applicant. Additionally, the applicant must submit all requested corrections and revisions as indicated on the Notice of Incomplete Application (NOIA LIC 184C) dated 8/20/20.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A Schnell	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

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: AFTERSCHOOL CARE ENRICHMENT-AT MARIPOSA	FACILITY NUMBER: 414004701
	VISIT DATE: 08/27/2020

NARRATIVE

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Sign-in/Sign out of the children will be completed by staff at drop off and pick up due to COVID-19, however, under regular operating procedures, parents will do this. The program also utilizes an agreement for alternative arrival and release of children from the program for children whose parents have authorized leaving the program on their own, or arriving on their own. This program will offer an afternoon snack, however due to COVID at this time parents provide all food and drink. The bathrooms were observed to be clean and with no health and safety hazards. Bathrooms are located on the school campus outside of the proposed rooms to be used. The sinks accessible to children do not deliver warmer than 120 degrees. There are sinks for children located in each classroom and a drinking fountain located in room T. The program will provide a pitcher with water and cups but due to COVID is currently providing bottled water. 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 area of the classroom and staff bathroom will be used for the child until the parent arrives for pick up.

Outdoor: The outdoor area (courtyard outside room T and S school play yard) was observed to be clean, safe and equipped with toys and equipment for children. Since the outdoor space is used for elementary school children as well as children that will be in this licensed after school care program, the applicant will ensure close supervision of the children and ensure there is not commingling of children from the elementary school and community in general, and the children participating in this after school care program. Bottled water will be used for drinking water outside. Shade for children is provided by shade structures.

Continued on 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: 08/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2020

LIC809 (FAS) - (06/04)

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