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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210110015
Report Date: 08/20/2024
Date Signed: 08/20/2024 12:45:49 PM


Document Has Been Signed on 08/20/2024 12:45 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:FAIRFAX SAN ANSELMO CHILDREN'S CENTERFACILITY NUMBER:
210110015
ADMINISTRATOR:TOMSKY, HEIDIFACILITY TYPE:
850
ADDRESS:199 PORTEOUS AVENUETELEPHONE:
(415) 454-1811
CITY:FAIRFAXSTATE: CAZIP CODE:
94930
CAPACITY:35CENSUS: 15DATE:
08/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Hiedi TomskyTIME COMPLETED:
12:40 PM
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On August 20, 2024, Licensing Program Analyst (LPA) Garcia arrived at the facility and met with director, Heidi Tomsky for an unannounced required inspection of the preschool facility. The facility is a combination center with preschool, infant and school ages licenses. Purpose of the inspection was explained. There were 15 children in care and there were a total of 5 teachers in the preschool program during the visit. Facility operates day care program Monday through Friday from 8:00 AM through 5:00 PM.

LPA inspected day care rooms and the outdoor space. LPA observed facility has combined smoke/fire and carbon monoxide detector, multiple fully charged fire extinguisher model 3A40BC located in each classroom. LPA tested the functionality of the detectors. The facility has a working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards.

There are first aid supplies available in the classroom. The bathroom is in working condition, LPA checked sinks and toilets. Individual items provided by the parents are labeled and stored appropriately. Per Heidi, the facility provides all foods and snacks which are prepped at the facility. Water is provided through filtered sink water, refilled as needed. All food is stored properly to avoid contamination. LPA observed that there are toys/books and manipulatives for the children to play.

LPA observed outdoor areas has a garden and age appropriate play structures are free from health and safety hazards. The outdoor area has shaded areas for the children to rest. The outdoor areas has a sand box, small benches, swings/slides and there are variety of toys and carts to ride on, available for the children. There are also sheds/bins and storage areas for the toys when they're not being used.

LPA reviewed the facility records. LPA reviewed 4 children's file during the visit. LPA reviewed 2 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. During staff file review, LPA observed that 2 of the teacher's files that were reviewed had expired mandated reporter training certificates as of May 2024. LPA reminded the director to review and renew necessary mandated reporter training certificates for all staff.


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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FAIRFAX SAN ANSELMO CHILDREN'S CENTER
FACILITY NUMBER: 210110015
VISIT DATE: 08/20/2024
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CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:


Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Based on record review and interview, the facility completed the lead water testing on April 5, 2023, without any exceedances. The testing was done after the deadline of January 1, 2023 which the facility was cited for on a Annual inspection on March 8, 2023. The facility is a combination center with Preschool facility#210110015, Infant facility #210110016 and School Age facility #210110017. Based on LPA review, the lead water testing results were all put under the preschool license# 210110015.

According to staff, the facility is using paper for sign in/out. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log and last drill was conducted on August 1, 2024. Per staff, drills are done at least every month rotating them between fire and earthquake drills and lock down drills.


The Director was reminded that all adults 18 and over, 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.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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.

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SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FAIRFAX SAN ANSELMO CHILDREN'S CENTER
FACILITY NUMBER: 210110015
VISIT DATE: 08/20/2024
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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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

According to staff, there are no children enrolled with allergies.
Incidental Medical Services – IMS. 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

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

See LIC 809D for deficiency cited during today's inspection.

A copy of this report was given with the “Notice of Site Visit” to the staff. A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed and signed by director, Heidi Tomsky.

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/20/2024 12:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: FAIRFAX SAN ANSELMO CHILDREN'S CENTER
FACILITY NUMBER: 210110015

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review)], the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/20/2024
Plan of Correction
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The facility will review staff files and renew necessary mandated reporter trainings by set due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan GarciaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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