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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005636
Report Date: 02/06/2023
Date Signed: 02/06/2023 12:05:07 PM

Document Has Been Signed on 02/06/2023 12:05 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SAN ANSELMO COOPERATIVE NURSERY SCHOOLFACILITY NUMBER:
214005636
ADMINISTRATOR:JENSEN, CHRISTIANFACILITY TYPE:
850
ADDRESS:3025 SIR FRANCIS DRAKE BLVD.TELEPHONE:
(415) 457-5990
CITY:FAIRFAXSTATE: CAZIP CODE:
94930
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 0DATE:
02/06/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:TIME COMPLETED:
12:12 PM
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On February 6, 2023 at 10:00 AM, Licensing Program Analyst (LPA) Sheran Lo met with Applicant Rebecca Nowlen today for a pre-licensing inspection. The applicant is requesting 28 children (ages 2 years to entry into first grade). The facility will operate Monday - Friday; 9:00 AM to 4:00 PM. The designated director/site supervisor for the facility is also applicant. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: There are three classrooms that will be used for the program and the following square footage was calculated for each room: Room 1- 1,400 sq ft. , Room 2- 625 sq ft., and Room 3- 240 sq ft. Total useable indoor square footage is 2,265 sq ft divided by 35 sq ft equals 64 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There are hangers for children's personal belongings and mats to be utilized for napping children. Facility will provide a sheet and blanket for children and bedding will sent home to be laundered weekly. Mats will be cleaned at least weekly or more often if needed. Children will be signed in and out with a sheet to be kept in classrooms. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, separate kitchen area where snack food is stored, garbage cans with tight-fitting lids, first aid and emergency supplies. The facility is adequately ventilated and free of insects and bugs. Windows are high up inaccessible to children. The program provides two snacks daily and parents will provide lunch for children in the afternoon program. Only disposable products will be used for food served by the facility. Snack foods will be stored in the kitchen separately from any cleaning products or other hazards. Medications will be stored in the staff area inaccessible to the children; there is a refrigerator located in this area for refrigerated medications.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SAN ANSELMO COOPERATIVE NURSERY SCHOOL
FACILITY NUMBER: 214005636
VISIT DATE: 02/06/2023
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There are _2 toilets (30 capacity) and 3 sinks (45 capacity) accessible for children's use. Bathrooms are located either inside the classrooms or in the hallway. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees. The program will provide a water dispenser and cups for children to drink water indoors. All toxins and other hazardous items will be stored in a locked cabinet in the classroom and will be inaccessible to children. Isolation of ill children will be located in the health office and staff bathroom will be used for an ill child.

Outdoor: The outdoor area measures over 3,000 sq ft. allowing for a total of 40 children. The outdoor area to be used is enclosed by at least a four-foot fence and observed to be clean, safe and equipped with toys and equipment for children. Resilient material located under climbing applicable climbing structures is a pour and play soft padding. There will be individual water bottles to allow children access to drinking water outside. Shade for children will be provided by building structures and trees.

Required postings were observed during today's inspection. Facility will conduct monthly disaster drills and a log will be maintained for review upon request. The fire inspection was conducted on February 3, 2023 which was approved. The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Facility does not use private water source. Information was provided to applicants during today's inspection. Advisory Note provided to applicants stating that the requirement for testing must be met by January 2023.

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.

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.

LPA will approve for Provisional License STD850 form is signed by fire marshal.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC809 (FAS) - (06/04)
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