414004803-9-2-2021-05-CC-GASL-C6GQLQ-20210902121620

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004803
Report Date: 09/02/2021
Date Signed: 09/02/2021 12:16:28 PM

Document Has Been Signed on 09/02/2021 12:16 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:	SHU ACADEMY		FACILITY NUMBER:	414004803
ADMINISTRATOR:	TING SHEN		FACILITY TYPE:	850
ADDRESS:	211 SOUTH DELAWARE STREET		TELEPHONE:	(650) 866-9121
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY: 38	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/02/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ting Shen		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) Glenn Schnell met with Applicant Ting Shen today for a pre-licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is a sole proprietor limited liability corporation and has applied for 38 children (ages 2 years to entry into first grade) and of the 38 children the applicant wants to designate 12 children for the toddler option program, ages 18 months to 36 months. The facility will operate Monday - Friday; 8:30 AM to 5:30 PM. The program is located in a free-standing building on commercial property, owned by the applicant. The designated director/site supervisor for the facility is Ting Shen. Ting Shen will be forfeiting her family child care home license in conjunction with the licensure date of this facility. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. Preschool Indoor: There are three classroom areas that will be used for the preschool program that wraps around to the back of the building and is subdivided by two half walls in the back. The other two rooms are located in the front of the building. There is a classroom in the center of the building that will be designated for the toddler option program. The following square footage was calculated for preschool areas: 1550.123 sq ft. divided by 35 sq ft equals 44 children. The following square footage was calculated for the toddler option classroom areas: 693.439 sq ft. divided by 35 sq ft equals 19 children (maximum group size will only allow for 12 children). The total square footage for the entire indoor space is 2243.562 divided by 35 sq ft per child equals 64 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.

Ali Zebila
Glenn A Schnell
	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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: SHU ACADEMY	FACILITY NUMBER: 414004803
	VISIT DATE: 09/02/2021

NARRATIVE

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There is storage space for children's personal belongings and cots to be utilized for napping children. The program will ask the parents to provide a sheet and blanket for their child, and bedding will be laundered weekly by the parents. Cots will be cleaned at least weekly or more often if needed by facility staff. Children will be signed in and out daily by manual signature. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, garbage cans with tight-fitting lids, first aid and emergency supplies.
The facility will require parents to provide all food, snack and drinks for their children. There is a small work area for the staff in the center of the facility located outside of where the children and staff bathrooms are. Emergency/back up snack foods will be kept here. The facility is adequately ventilated and free of insects and bugs.
Medications will be stored in the office or in cabinets in the classrooms inaccessible to the children; There are 3_toilets (45 capacity) and_3 sinks ( 45 capacity) accessible for children's use. Children in the toddler option program will share the bathroom with the preschool children and use the bathrooms at separate times.
The bathrooms were observed to be clean and with no health and safety hazards. There is a diaper changing table and sink in the toddler option classroom. Sinks accessible to children deliver water that is no warmer than 120 degrees. The program will provide pitcher of water and cups in the classroom for children to drink water indoors. All toxins and other hazardous items will be stored in locked cabinets in the classrooms and will be inaccessible to children. Isolation of ill children will be located in the director office and the adult bathroom will be used for an ill child.
Outdoor Area: The outdoor area measures 2026.68 sq ft. allowing for a total of 27 children. The outdoor area to be used is enclosed by at least a four foot fence and observed to be clean, safe and equipped with toys and equipment for children. There are two climbing/play structures, one with sand as resilient material, the other with wood chips. Pitchers of water and cups for drinking will be accessible to children outside. Shade for children will be provided by the building awning and the climbing structures. Children in the toddler option program will share the preschool playground at separate scheduled times. The applicant is requesting a waiver to rotate all children on the playground in groups of no more than 27 children. Applicant will also submit a rotation schedule with the request.

SUPERVISOR'S NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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: SHU ACADEMY	FACILITY NUMBER: 414004803
	VISIT DATE: 09/02/2021

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- staff will talk with the children and use redirection, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service-none provided, Transportation-none provided, Parents Rights, and Reporting Requirements. Required postings were reviewed during today's inspection. Facility will conduct monthly disaster drills and a log will be maintained for review upon request. A fire clearance for capacity of 38 children has been approved.
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 Title 22 Regulations 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
LPA Schnell reviewed the completed COVID-19 self assessment guide with the applicant. LPA also reviewed COVID-19 required postings. Applicant was informed that access to available Personal Protective Equipment (PPE) may be available through the local child care resource and referral agency.
The requirement for the testing of lead in the water was discussed (H&S Code 1597.16). LPA informed the director/licensee to review Provider Information Notice 21-21-CCP (dated 7/28/21) for directives and regulations regarding obtaining a test of the water for lead, and how that information is to be documented and reported to Community Care Licensing. Advisory Note provided to applicants stating that the requirement for testing must be met by January 2023.
Report was reviewed and signed by Ting Shen. Today’s report, 9/2/21, will be sent to Ting Shen at shuacademysanmateo@gmail.com by close of business, 9/2/21. Confirmation of receipt is required.
LPA Schnell will recommend licensure of this facility for a capacity of 38 children, with no more than 12 being toddler option age, effective today 9//2/21.

SUPERVISOR'S NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

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