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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004701
Report Date: 09/17/2021
Date Signed: 09/17/2021 02:06:07 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 MARIPOSAFACILITY NUMBER:
414004701
ADMINISTRATOR:RUIZ, VICTORIAFACILITY TYPE:
840
ADDRESS:750 DARTMOUTH AVENUETELEPHONE:
(650) 226-3480
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY:60CENSUS: 0DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:13 PM
MET WITH:Victoria RuizTIME COMPLETED:
12:20 PM
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On September 17, 2021 at 12:04 PM, Licensing Program Analyst (LPA) Cowan met with director and licensee for a 1-Year Required Inspection. The purpose of the inspection is explained. Present this day is licensee, director, and staff member Elyse Yousef. There are no children in care at this time. Children will arrive at 3:05 PM. Facility operates day care Monday to Friday from 07:30 AM to 06:00 PM. Facility consist of two classrooms: S and T. The facility is located on the property of Mariposa upper elementary school.

With director and staff, LPA inspected the day care rooms and play yard. LPA observed facility has smoke detector, carbon monoxide detector, fully charged fire extinguisher and working telephone on site. Each child has their own cubby located just outside of the class room. All cleaning solutions, poisons and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Facility floor is in good repair and free of any hazards.

There are first aid supplies available in the classroom. All bathrooms are in working condition. All food is stored properly to avoid contamination. Food preparation area is free of litter. Food is stored adequately to prevent contamination. Play yard is free of hazards. There is water available on the yard as well as in the classroom.
Report Continues on next page
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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: AFTERSCHOOL CARE ENRICHMENT-AT MARIPOSA
FACILITY NUMBER: 414004701
VISIT DATE: 09/17/2021
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LPA discussed Covid-19 precautions, sick children, Medications, .
Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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. 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

>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.

This report must be available in the facility for public review. Notice of site visit was observed being posted. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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