414004812-10-1-2021-05-CC-LTMO-C7E32T-20211001175225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004812
Report Date: 10/01/2021
Date Signed: 10/01/2021 05:52:33 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:	EASTER, KYNDAL		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:	10/01/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Arturo Cervantes and Nathalie Carvajal		TIME COMPLETED:	11:05 AM

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	On October 1, 2021, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, case management inspection initiated by facility. LPA met with Operation Managers, Arturo Cervantes and Nathalie Carvajal . Purpose of the inspection was explained. Children are currently not present as the facility is moving doing change of room use. Facility is currently licensed to operate in Classrooms #18, #19, #20, #22, #23 and #24. Facility has requested to change rooms to Classrooms #3, #4, #5, #6, #7, and #12. The facility will operate Monday - Friday from 8:30 AM to 4:15 PM. The facility was inspected indoor today for health and safety hazards and measured to calculate capacity. Indoor: Classrooms #3, #4, #5, #6, #7, and #12. measured about 3,974.292 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 2 child size toilets and 2 child size sinks. 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: There has been no change in the outdoor area. 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. Facility has an approved waiver for Outdoor Play. 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: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

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: 10/01/2021

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.
>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.

No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

Child Care Center License is approved for capacity of 98 Preschool children (ages 3-4 years) in Classroom #3, #4, #5, #6, #7, and #12 and will be effective as of today, 10/01/21.

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: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

LIC809 (FAS) - (06/04)

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