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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380500099
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:46:30 PM

Document Has Been Signed on 05/17/2023 03:46 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:CALVARY PRESBYTERIAN CHURCH NURSERY SCHOOLFACILITY NUMBER:
380500099
ADMINISTRATOR:ANAYA, DEBORAHFACILITY TYPE:
850
ADDRESS:2515 FILLMORE STREETTELEPHONE:
(415) 346-4715
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 62DATE:
05/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Deborah AnayaTIME COMPLETED:
01:30 PM
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 On May 17, 2023 at approximately 11:15am, Licensing Program Analyst (LPA) Ly conducted an Unannounced Required - 1 Year Visit at and met with Site Director, Deborah Anaya during the visit. Purpose of the inspection was explained. There are 12 staff members including the Director caring for 62 children. Teacher to child ratios were met on this day. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and a carbon monoxide detector. The facility operates Monday - Friday from 8:30AM to 3:00PM. The center uses clipboards for parents to sign their children in and out of the program. Facility has posted all the required licensing forms in a prominent visible location.

LPA and Site Director inspected the center for Health and Safety Hazards. The facility has classrooms. There are 4 classrooms on the third level (Bluebirds, Redbirds, Penguins, Eagles) and one classroom (Sea Lions) on the first level of the building. There are no pools, spas or other bodies of water on the premises. Per the Site Director, there are no firearms or weapons in the center. Adequate first aid supplies are available. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored in locked cabinet and in emergency back pack inaccessible to children. Furniture and equipment are in good condition, free from loose, sharp or pointed parts. Children's bathrooms are in working order with adequate supplies. There are separate bathrooms on site for adults. The center provides morning snacks to the children. Children bring their own lunches. Drinking water is provided indoor and outdoor by children's own water bottles.

LPA and Site Director also toured the rooftop outdoor play area for Health and Safety Hazards. LPA observed outdoor equipment is in good condition, free from loose, sharp or pointed parts. The play structure appears to be age appropriate for children in care. Last Emergency Drill was conducted on 05/04/2023 and properly logged.

A random sample of children's and staff’s files were reviewed and found to be complete. At least one staff have current Pediatric First Aid and CPR.

CONTINUED>>>
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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: CALVARY PRESBYTERIAN CHURCH NURSERY SCHOOL
FACILITY NUMBER: 380500099
VISIT DATE: 05/17/2023
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This facility provides Incidental Medical Services-IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care 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.

LPA discussed Child Abuse Mandated Training AB1207 with the Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

An Exit Interview was conducted with Director. No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations. A copy of this report and appeal rights were discussed and left with Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days. For updates on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
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