414004812-8-17-2021-05-CC-LTMO-C5YRQN-20210817131349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004812
Report Date: 08/16/2021
Date Signed: 08/17/2021 01:13:59 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:	PRIMARY SCHOOL, THE		FACILITY NUMBER:	414004812
ADMINISTRATOR:	CERVANTES, ARTURO		FACILITY TYPE:	850
ADDRESS:	2086 CLARKE AVENUE		TELEPHONE:	(650) 396-2779
CITY:	EAST PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY:	98	CENSUS: 0	DATE:	08/16/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Arturo Cervantes		TIME COMPLETED:	03:40 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), Leslit Tapia-Mandujano and Licensing Program Manager, Cindy Interiano conducted a PreLicensing inspection and met with Operations Manager, Arturo Cervantes. Purpose of the inspection was explained to Operations Manager. Facility has requested a license capacity of 98 preschool children (ages 3-4 years). Facility will temporarily operate in Classroom #18, #19, #20, #22, #23 and #24. The facility will operate Monday - Friday from 8:30 AM to 4:15 PM. The facility was inspected indoor and outdoor today for health and safety hazards and measured to calculate capacity. Indoor: Classrooms #18, #19, #20, #22, #23 and #24 measure about 5,851.47 square feet exceeding the desired capacity of 98 children. All classrooms have sufficient toys, cubbies, and equipment for children. Rooms are equipped with a fire alarm, a smoke and carbon monoxide detector, and a fire extinguisher. All classrooms have a child size sink/drinking fountain with no hot water. Restrooms are located outside of the classrooms; Bathroom #1 (2 toilets, 3 urinals, and 2 sinks) located around the corner to the left and Bathroom #2 (4 toilets and 3 sinks) located to the left of Classroom #22. Classrooms have a fully supplied Emergency kit or backpack. Isolation area of ill children will be in the office area, until Guardian arrives for pick up. Children’s medication will be kept in the Classroom #13 which will be where the Health Manager and Nurse will be. Drinking water is readily available for children. All mandatory postings are posted in each classroom. Outdoor: The outdoor area measures 6,570 square feet allowing for a total capacity of 87 Preschool children. Outdoor play area is equipped with an age appropriate play structure and soft floor cushioning. Drinking water is available for children. Play area is enclosed by a fenced area. See facility sketch and capacity worksheet. Continued on Page 2...

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

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: PRIMARY SCHOOL, THE	FACILITY NUMBER: 414004812
	VISIT DATE: 08/16/2021

NARRATIVE

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During today’s Inspection the following was discussed with the Operations Manager:

>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. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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
>Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.
>Subscribe to receive Provider Information Notices (PINs) on CCLD website.
>Mandated Reporter Training available on CCLD website. Training must be renewed by all staff every 2 years.
>New Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts, as well as additional requirements for Child Care Centers. Review PIN 21-21-CCP for additional information/instructions.
>Covid-19 guidelines was discussed.
>Food preparation procedure and guidelines
>Reminded that at least 1 staff must have current CPR/First Aid.
>Reminded to conduct fire drills at least once every six months and properly log drill.
>Reminded of records to be maintained at the facility.

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SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PRIMARY SCHOOL, THE	FACILITY NUMBER: 414004812
	VISIT DATE: 08/16/2021

NARRATIVE

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Items that need to be completed:

Inside Classrooms:
1) Cover “big metal box” in each classroom with soft padding
2) Cover the cube “Phone Jacks” in classrooms with soft padding
3) Extra padding and rearrangement of trampoline in classrooms
4) Fire Extinguishers need to be fully charged
5) Menus to be posted in each classroom

Outdoor play area
6) Clear pathway free of hazardous materials on walkway to outdoor play area
7) Clean and clear outdoor play area of any hazardous objects
7) Additional shading should be installed

8) Applicant will send photos of requested information
9) Forms requested need to be submitted
a. Board Resolution
b. Updated Emergency Disaster Plan
c. Health Screening for Director
d. Outdoor play waiver will be pending review
10) Transfer Fingerprint Clearance of all staff

A provisional Child Care Center License is approved for capacity of 98 Preschool children (ages 3-4 years) in Classroom #18, #19, #20, #22, #23, and #24, and will be effective as of today, 08/16/2021.

A regular License will be issued once final review of the application is made, Regional
Manager reviews outdoor waiver request.

Report will be emailed to Operation Manager at Arturo.cervantes@theprimaryschool.org. Confirmation of receipt is required. Copy of the signed report will be kept in file. Report must be available for public review. Any additional questions to call Office, M-F, 8a-5p, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC809 (FAS) - (06/04)

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