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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005608
Report Date: 09/18/2024
Date Signed: 09/18/2024 03:51:45 PM

Document Has Been Signed on 09/18/2024 03:51 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:OLD FIREHOUSE SCHOOLFACILITY NUMBER:
214005608
ADMINISTRATOR/
DIRECTOR:
CRISTINA BLOUINFACILITY TYPE:
830
ADDRESS:1510 FIFTH AVENUETELEPHONE:
(415) 419-5479
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 13TOTAL ENROLLED CHILDREN: 1CENSUS: 1DATE:
09/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Cristina BlouinTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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On 9/18/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit and met with the Director, Cristina Blouin. LPA explained the purpose of the visit to the director. This location also has a preschool program under license number 214005607.

One infant and two staff members were present during the visit. The two staff members received criminal record clearance from the department. The facility is within its capacity limits and ratios for today’s visit.

LPA observed that all required documents, such as the facility license, waivers, notification of parents’ rights, personal rights, car seat laws, emergency disaster plan, and daily activities schedule, were displayed in a prominent, publicly accessible location.

LPA observed one child in the outdoor play area, which complies with their outdoor waiver, allowing up to five children to be in the outdoor play area at a time.

The most recent emergency disaster drill was conducted on 12/20/2023, and the LPA observed that it was properly documented. LPA reviewed the emergency disaster drill log and found that it has not been conducted for this school year since the facility reopened on 8/20/2024 from summer break. LPA reminded the director to complete and properly record them every six months.

The facility was observed to have first aid kits, functioning smoke and carbon monoxide detectors, and fully charged fire extinguishers. The first-aid supplies were maintained in a location accessible to staff but inaccessible to children.

LPA inspected the indoor and outdoor areas to identify health and safety hazards. The facility was clean, safe, sanitary, and in good repair. Disinfectants, cleaning solutions, poisons, and other items that could pose a danger were stored in areas inaccessible to the children. All accessible cabinets and drawers in the classrooms were found to be free of hazardous materials or poisons.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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: OLD FIREHOUSE SCHOOL
FACILITY NUMBER: 214005608
VISIT DATE: 09/18/2024
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LPA observed that the classroom had age-appropriate toys, furniture, educational materials, and designated storage space for each child. The classroom had a diaper-changing table within arm’s reach of a sink. LPA observed that all containers used for storage of solid waste, including movable bins, have a tight-fitting cover. The bathrooms were found to be clean and fully operational. The toilets and handwashing facilities were well-kept, safe, and clean.

The outdoor playground has a fence at least four feet high. The outdoor play equipment is in good condition and has no sharp, loose, or pointed parts. The areas around and under high climbing equipment, swings, slides, and similar equipment were observed to be cushioned with a rubberized mat. No bodies of water, such as pools or spas, were on site.

The infant program does not currently provide food service for the children. The children's parents or guardians provide lunches for their children. LPA observed that one child had a lunch box in their designated storage space. According to the director, none of the enrolled children have allergies. The facility provides snacks for the children.

Children's mattresses, sheets, and blankets are provided for sleeping or napping. According to the director, the facility washes the sheets and blankets weekly.

LPA observed that the facility currently records each child's attendance electronically, accounting for the parent's signature. LPA reviewed one child’s file and found it did not have the child’s immunization record, forms LIC 701 and 702. The file included the child’s emergency contact information and records of the child’s 15-minute sleep checks. LPA requested the director to email the department with the child’s immunization records and forms LIC 701 and 702 as soon as they are completed. The director stated the child started on 8/22/2024, and the parent is still waiting for a doctor’s appointment. The director stated the parent will return the missing forms once they can get an appointment with the doctor.

LPA reviewed the files for two staff members and confirmed that one was current with their Pediatric First Aid/CPR certifications. LPA found that two staff members had completed the necessary twelve units in Early Childhood Education (ECE), including the ECE infant/toddler units, which meet the qualifications required to be classified as a teacher.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: OLD FIREHOUSE SCHOOL
FACILITY NUMBER: 214005608
VISIT DATE: 09/18/2024
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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.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: OLD FIREHOUSE SCHOOL
FACILITY NUMBER: 214005608
VISIT DATE: 09/18/2024
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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

No deficiencies were issued today during LPA's visit.

A copy of today’s report was given to the director.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Cristina Blouin.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
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