214005667-1-26-2024-05-CC-CQUO-CZUSAB-20240126124204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005667
Report Date: 01/26/2024
Date Signed: 01/26/2024 12:42:11 PM

Document Has Been Signed on 01/26/2024 12:42 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	NATIVITY OF CHRIST GREEK ORTHODOX CHURCH		FACILITY NUMBER:	214005667
ADMINISTRATOR:	CUMMINGS, DAPHNE		FACILITY TYPE:	850
ADDRESS:	1110 HIGHLAND DRIVE		TELEPHONE:	(415) 883-1998
CITY:	NOVATO	STATE: CA	ZIP CODE:	94949
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/26/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	John Kocolas, Eleni Kelley, Daphne Cummings		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On January 26, 2024 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted a scheduled, pre-licensing inspection. LPA met with applicant, Father John Kocolas, administration director, Eleni Kelley, and preschool director, Daphne Cummings, and explained the purpose of the visit. The Nativity of Christ Greek Orthodox application was received November 17, 2023. Fire inspection was conducted January 11, 2024. As of this date, fire clearance has not been received in office. The applicant is requesting for a preschool program with a capacity of 15 children. Applicant is planning to serve children ages 2 years to entry into first grade. The facility will operate Monday through Friday in a part time and full time program. The part time program will operate 8:30am to 12:00pm. The full time program will operate through 3:00pm. Applicant plans for children to be signed in and out of facility with authorized representatives' written signatures. The designated director for the facility will be Daphne Cummings. The facility was inspected indoors and outdoors, for health and safety hazards, and measured to calculate capacity. Indoors: There are 3 classrooms that will be utilized for the preschool program: Preschool classroom #1, Preschool classroom #2, and Preschool classroom #3. The facility also includes a kitchen space that is made off limits to children with a child safety gate. Preschool classroom #1 was measured for 263.12 sq. ft. allowing for a capacity of 7 children. Preschool classroom #2 was measured for 270.85 sq. ft. allowing for a capacity of 7 children. Preschool classroom #3 (located next to kitchen) was measured for 534.33 sq. ft. allowing for a capacity of 15 children. Total indoor square footage equals 1,068.3 sq. ft. allowing for a capacity of 30 children. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NATIVITY OF CHRIST GREEK ORTHODOX CHURCH	FACILITY NUMBER: 214005667
	VISIT DATE: 01/26/2024

NARRATIVE

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LPA observed classrooms to be well ventilated with appropriate temperature. Each classroom is equipped with furniture, toys and materials that were age appropriate and in good working condition. Flooring in classrooms were observed to be clean with new carpets. Garbage bins were observed to have tight fitting lids. There is sufficient storage space for children's personal belongings through cubbies.

Per administration director, electrical outlets in classrooms are "tamper free" outlets. LPA reminded administration director poisons, cleaning supplies, and hazardous materials must be made inaccessible to children. Facility is equipped with a fully charged fire extinguisher, fire sprinklers, fire alarm system and multiple dual smoke/carbon monoxide detectors.

Medication for children will be stored in a locked box with required documentation, inaccessible to children. This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) tollfree 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, available at: http://www.ada.gov/childqanda.htm.

Program plans to provide napping children with cots. Children's families are to provide sheets and blankets for napping children. Sheets and blankets will be stored in children's cubbies. Sheets will be sent home weekly or as needed. Cots will also be sanitized weekly or as needed.

There is one restroom (women's restroom) that is labeled for children's use only. Restroom includes 3 toilets and 3 sinks. Total allowable capacity for toilets is 45 children. Total allowable capacity for sinks is 45 children. Sinks accessible to children do not provide water that is warmer than 120 degrees Fahrenheit. LPA observed restroom to be in working condition, equipped with appropriate toileting equipment and sanitation products.

Director plans for isolation area to be the Church office. LPA reminded director children must always be supervised going to and from the restroom and when in isolation area. Program's discipline policy was discussed. Director plans for children to be redirected with positive reinforcement.
(Continue Report on Page 3...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NATIVITY OF CHRIST GREEK ORTHODOX CHURCH	FACILITY NUMBER: 214005667
	VISIT DATE: 01/26/2024

NARRATIVE

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Program does not plan to provide a food service. Children's families are to provide food for the children. LPA reminded director children's lunch boxes must be labeled with their individual names. The kitchen in the facility will not be utilized for children's use.

Water will be made available with children's individual water bottles. Applicant is currently deciding if water jugs will be purchased from an outside vendor as a way to refill children's water bottles or if water will be refilled on site through a water fixture.

The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Applicant and directors were informed a facility licensed after July 1, 2022, must have their water fixtures tested for lead 180 days after licensure and every 5 years thereafter. LPA advised applicant and directors to review PIN 21-21-CCP.

Outdoor: Access to the outdoor area is located directly outside classroom#1 and classroom #3. Total outdoor area was measured for 1,289.70 sq. ft. allowing for a capacity of 17 children. LPA informed applicant and directors of submitting a outdoor, rotation waiver request. LPA observed outdoor area is equipped with play structures. LPA observed there to be resilient padding underneath play structures. Outdoor area is fully fenced with an at least 4 ft. high fence. Applicant and directors were reminded fully fenced outdoor area is only space to be utilized for preschool children. There is adequate shade in the outdoor area. Applicant plans to install additional shade in the future.

LPA reviewed with applicant and directors, the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA reminded directors emergency disaster drills must be conducted and documented at least once every six months.

Applicant and directors were 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, 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.
(Continue Report on Page 4...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NATIVITY OF CHRIST GREEK ORTHODOX CHURCH	FACILITY NUMBER: 214005667
	VISIT DATE: 01/26/2024

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Applicant and directors were informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed
facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.

Based on indoor square footage, maximum number program can be licensed for is 30 preschool children.

Prior to recommended licensure, following must be completed:
-Fire clearance with updated capacity.
-Outdoor waiver approval.
-Posting of licensing documentation.
-Record Keeping orientation for director.
-Signed LIC503 for director.

Exit interview conducted and report was reviewed with the applicant, Father John Kocolas.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC809 (FAS) - (06/04)

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