414004875-5-9-2022-05-CC-HRCO-CE9NNB-20220509103624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004875
Report Date: 04/26/2022
Date Signed: 05/09/2022 10:37:01 AM

Document Has Been Signed on 05/09/2022 10:37 AM - 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:	COMMUNITY CARE PRESCHOOL		FACILITY NUMBER:	414004875
ADMINISTRATOR:	YU, KELI		FACILITY TYPE:	850
ADDRESS:	450 CHADBOURNE AVENUE		TELEPHONE:	(650) 690-0998
CITY:	MILLBRAE	STATE: CA	ZIP CODE:	94030
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 0	DATE:	04/26/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	William David Chow and Keli Yu		TIME COMPLETED:	04:25 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) Haydee Caliboso met with William David Chow (Program Bookkeeper) and Keli Yu (Program Director) for pre-licensing inspection on 4/26/22. The applicant has requested for a capacity of 45 preschool children, ages 2 to 6 years old. The facility building that will be used for the program is on the lower level of a commercial building and plans to operate Monday - Friday; 8:00AM to 5:30PM. The designated Site Supervisor for the preschool program will be Melissa Won. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. Indoor: There are 3 classrooms that will be used for the program; preschool classroom, manipulative classroom, and the atelier classroom. The following square footage was calculated for each classroom; preschool classroom 1,311.83 sq. ft allowing for a capacity of 36 children, manipulative classroom 164.51 sq. ft allowing for a capacity of 5 children, and the atelier classroom 118.37 allowing for a capacity of 4 children. The total indoor classroom space that will be used for the program measures 1,558.91 sq. ft allowing for a capacity of 45 children. The classrooms and furniture equipment are clean and in good condition. Children’s toys and supplies are orderly, in good condition, and age appropriate. There is storage space for children's personal belongings and cots to be utilized for napping children. Parents will provide a sheet and blanket for their child. Bedding is sent home to be washed weekly or as needed. Cots will be cleaned daily or as needed. The classroom is equipped with a fire extinguisher, smoke, and carbon monoxide detectors. The classroom has a kitchen area with a working refrigerator where snack food is stored. Each classroom has garbage cans with tight-fitting lids. The program has a designated backpack with a first aid kit and emergency supplies. Cont. 809-C pg. 2

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022

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: COMMUNITY CARE PRESCHOOL	FACILITY NUMBER: 414004875
	VISIT DATE: 04/26/2022

NARRATIVE

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Refrigerated medications will be stored separately from food. Medication will be administered with parental consent and will be kept in the child’s file for record. All medication will be logged when administered to children. The program will provide morning and afternoon snacks daily and parents will provide lunch. Parents will provide water bottle. In addition, the program will provide water for indoor and outdoor use.

There are total of 3 sinks and 2 toilets, 1 urinal available for children to use. The capacity for 3 toilets/urinal is 45 children, and the capacity for 3 sinks is 45 children. The bathroom is clean and does not have any health or safety hazards. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children. There are designated bathrooms for staff to use. The isolation area for ill children is at the Program Director office, and staff restrooms will be used for ill children located at the 2^nd floor of the building, if needed, until parents arrive for pick-up.

Outdoor: The playground was calculated for 1,467.96 sq. ft, allowing for a capacity of 19 children. The program has a designated outdoor “bike track” area which was calculated for 702 sq. ft allowing for a capacity of 9 children at time and no other conflicting activities. The outdoor area is enclosed and was observed to be safe and equipped with toys that are age-appropriate for children. There is a tree that will be used for a natural shade. The playground has climbing structures. Rubber mat is used for cushion. There are age-appropriate toys in good condition in the playground made accessible for children to use. The program will submit and request for outdoor rotation waiver. Program Director was reminded to ensure constant supervision and ratio are observed at all times. The facility will conduct and log fire drills once every six months, and the log will be available upon request.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Cont. 809-C pg. 3

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022

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: COMMUNITY CARE PRESCHOOL	FACILITY NUMBER: 414004875
	VISIT DATE: 04/26/2022

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication

An electronic copy of this three-page report was emailed Keli Yu. Applicant was asked to review and sign the report.

Based on available square footage, sinks, and toilets, LPA Haydee Caliboso will recommend licensure of this facility for a maximum capacity of 45 children. The following is required prior to licensure:

· Fire approval from Millbrae Fire Department
· Scheduled outdoor rotation letter
· LIC 404

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022

LIC809 (FAS) - (06/04)

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