214005552-8-22-2023-05-CC-NGAA-CUXT2R-20230822142110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005552
Report Date: 08/22/2023
Date Signed: 08/22/2023 02:21:23 PM

Document Has Been Signed on 08/22/2023 02:21 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:	SUSD- TOMALES PRESCHOOL		FACILITY NUMBER:	214005552
ADMINISTRATOR:	CUMMINGS, DAPHNE		FACILITY TYPE:	850
ADDRESS:	40 JOHN STREET		TELEPHONE:	(707) 878-2214
CITY:	TOMALES	STATE: CA	ZIP CODE:	94971
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 8	DATE:	08/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:26 AM
MET WITH:	Daphne Cummings		TIME COMPLETED:	02:30 PM

NARRATIVE

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On August 22, 2023 at approximately 11:00 AM, Licensing Program Analyst (LPA) Nathan Garcia met with director, Daphne Cummings, for an unannounced annual inspection for the pre school facility. Purpose of the inspection was explained. There were 8 children and 2 teachers and the director present during the visit. Facility operates day care program Monday - Friday from 8:30 AM-2:45 PM for the school year.

With Daphne, LPA inspected 1 day care room and the outdoor space. LPA observed facility has multiple smoke detectors and carbon monoxide detectors, multiple fully charged fire extinguisher model 3A40BC located on multiple areas. 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 classrooms and in the office. All bathrooms are in working condition. Individual items provided by the parents are labeled and stored appropriately. According to Daphne, the facility serves Breakfast, and Lunch all prepped on site. Per staff, the children are provided through filtered water through tap as main source of drinking water, refilled as needed. The kids mainly bring their water bottles from home. All food is stored properly to avoid contamination. Food is stored adequately to prevent contamination and properly labeled. There is water available for children in the yard as well as in the classrooms and emergency bags.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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: SUSD- TOMALES PRESCHOOL	FACILITY NUMBER: 214005552
	VISIT DATE: 08/22/2023

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LPA observed multiple outdoor areas and play structures are free from health and safety hazards. The outdoor area has a large structures with slides, padded floor with wood chips underneath the structures. There are a variety of toys and sport equipment available for the children. There are also sheds/bins and storage areas for the toys when they're not being used. Per director, part of the outdoor area will have turf installed in the next few weeks.

CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE
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).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
According to Daphne, the facility is under the Shoreline Unified School District and they do a monthly water test that is uploaded and reported to the State Water Board.

According to the Daphne, 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 May 9, 2023. Per Daphne, drills are done at least every month. The school also rotates them between lock down/fire and earthquake drills.

The LPA reviewed the facility records. LPA reviewed 4 children's files during the visit. LPA reviewed 2 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. The facility has a set learning curriculum and schedule posted in the classroom.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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: SUSD- TOMALES PRESCHOOL	FACILITY NUMBER: 214005552
	VISIT DATE: 08/22/2023

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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.

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.

This facility provides Incidental Medical Services – IMS. According to staff, they don't have current students with severe allergies. 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

Type B violation for incomplete Lead Water Testing.

Report was reviewed and signed by director, Daphne Cummings.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/22/2023 02:21 PM - It Cannot Be Edited

Created By: Nathan Garcia On 08/22/2023 at 02:12 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SUSD- TOMALES PRESCHOOL	FACILITY NUMBER: 214005552
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/29/2023
	Plan of Correction
1 2 3 4	Director will send confirmation of the appointment and results from the certified lead water samplers.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Oquendo

LICENSING EVALUATOR NAME:

Nathan Garcia

LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC809 (FAS) - (06/04)

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