214005617-2-29-2024-05-CC-NGAA-D2WSGC-20240229125144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005617
Report Date: 02/29/2024
Date Signed: 02/29/2024 12:51:55 PM

Document Has Been Signed on 02/29/2024 12:51 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:	GROVE PRESCHOOL AT KOL SHOFAR, THE		FACILITY NUMBER:	214005617
ADMINISTRATOR:	BARBONI, KATHERINE		FACILITY TYPE:	850
ADDRESS:	215 BLACKFIELD DRIVE		TELEPHONE:	(415) 388-1818
CITY:	TIBURON	STATE: CA	ZIP CODE:	94920
CAPACITY: 105	TOTAL ENROLLED CHILDREN: 105	CENSUS: 53	DATE:	02/29/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Lisa Monge/Katherine Barboni		TIME COMPLETED:	01:15 PM

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On February 29, 2024, Licensing Program Analyst (LPA) Garcia arrived at the facility and met with assistant director, Lisa Monge for an unannounced required inspection for the preschool facility. Preschool director, Katherine Barboni, later joined the inspection. Purpose of the inspection was explained. There were total of 53 children in care, with 12 teachers. Rooms Tamarin, Etzim, Zetim, Anavim had 47 preschool children and 6 children in room Rimonim for the toddler component. Facility operates day care program Monday through Friday from 8:30 AM through 5:30 PM.

LPA inspected day care rooms and the outdoor space. LPA observed facility has combined smoke/fire and carbon monoxide detector, a fully charged fire extinguisher model 3A40BC located in each rooms. 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 Lisa, the facility does not provide any food and all foods are brought from home. Water is provided through water fountain or from the sink, refilled as needed. All food is stored properly to avoid contamination. Food is stored adequately to prevent contamination and properly labeled.

LPA observed outdoor areas and play structures are free from health and safety hazards. The outdoor area has play structures, and shaded areas for the children to rest. A covered sand box, playhouses and a ball pit. The Toddler component outdoor area is separate from the preschool area. There are a 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.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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: GROVE PRESCHOOL AT KOL SHOFAR, THE	FACILITY NUMBER: 214005617
	VISIT DATE: 02/29/2024

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CCC COMPLETED TESTING AND REMEDIATED ALL 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).

LPA observed the affected sink located in the art room/kid's kitchen "O" relabaled as "A" was retested on 10/6/2023 with results below 5 ppb of lead threshold.

According to Lisa, the facility is using Bright Wheel Application 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 November 12, 2023. Per Katherine, drills are done every month.

LPA reviewed the facility records. LPA reviewed 10 children's files during the visit. LPA reviewed 6 staff files with qualifying requirements such ECE Units, CPR and Mandated Reporter Training. Licensing forms and sleep logs were reviewed and present.

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.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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: GROVE PRESCHOOL AT KOL SHOFAR, THE	FACILITY NUMBER: 214005617
	VISIT DATE: 02/29/2024

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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.

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 the director, there is a child with nut allergies. LPA inspected the dates and paperwork of the medication. 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

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

A copy of this report, and the “Notice of Site Visit” were given to the Director.

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 by director, Katherine Barboni.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC809 (FAS) - (06/04)

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