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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505568
Report Date: 01/17/2023
Date Signed: 01/17/2023 02:27:28 PM

Document Has Been Signed on 01/17/2023 02:27 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:FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)FACILITY NUMBER:
380505568
ADMINISTRATOR:QUIROZ, YOHANAFACILITY TYPE:
850
ADDRESS:2730 BRYANT STREETTELEPHONE:
(415) 282-1090
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 63DATE:
01/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rosara Diaz, Felisha Johnson, Mechele Pruitt, Sueli NunesTIME COMPLETED:
02:35 PM
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On 1/17/2023 at 10:00AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Early Learning and Family Support Senior Director, Rosaura Diaz, Co-Education Director, Sueli Nunes and Co-Education Director, Mechele Pruitt. Purpose of the inspection was explained and was for an unannounced Annual/ Random inspection. Facility is combination center with infant program on-site. Present was the director and 15 staff supervising 63 children. All staff have criminal record clearances on-file. Preschool program operates out of four classrooms: Sunshine, 3-4 years old; Starfish, 3-4 years old; Bumble Bees, 3-6 years old; Blue Birds, 4-6 years old and one, shared, outdoor play yard. Outdoor space waiver was observed posted in lobby during inspection. Hours of operation are Monday- Friday 7:30am- 4:30pm. Program operates year around. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 10:25AM., LPA observed the following: Classrooms were clean and orderly, with a variety of age-appropriate plaything available for the children. Floors and ground surfaces were free of obstructions. Each classroom was equipped with labeled cubbies for storage of child’s belongings. Books and materials were in good repair, and free of sharp corners or splinters. Classrooms had child sized tables and chairs for lunch and seated activities. Fixtures in children's bathrooms were in operating condition. Children’s bathrooms had adequate supplies for hand washing and changing table. Staff bathroom is located separately. For napping services, program provides napping cots, assigned to each child. Per director, napping supplies are taken home weekly to be washed. Classrooms had acceptable ventilation and lighting. Child safety lock have been installed on accessible cabinets and drawers.

LPA reminded director to ensure detergents, cleaning supplies and toxins are stored inaccessible. Advisory Note: Technical Assistance was issued (LIC9102TA).

Classrooms have functioning smoke detector, carbon monoxide detector and fire extinguishers (2A:60BC) located in hallway. First aid kit was fully stocked.

At 11:05AM., LPA inspected the outdoor play area. Outdoor play area was enclosed with tall fencing. Outdoor space was observed free of debris or hazardous plants. Tricycles and equipment inspected were in good repair and play structure was properly anchored. LPA reminded facility to ensure water services are provided at all times. (REFER TO 809-C FOR CONT.)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)
FACILITY NUMBER: 380505568
VISIT DATE: 01/17/2023
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At 11:45AM LPA review facility records including seven children’s files and five personnel files. Staff files reviewed and included: Proof of Education Requirement; Criminal Record Statement (LIC508); Mandated Reporter Training (AB1207); and Proof of required Immunization.

Children’s files reviewed and included the: Consent for Medical Treatment (LIC627); Updated Immunization Record, Identification of Emergency Information (LIC700); Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

Present staff member had their current CPR/ 1st aid certification, which expires on: 04/2023. Emergency disaster drills are conducted every six months with the last drill completed on, 10/20/2022 and properly logged. Facility provides all daily meals. Refrigerators inspected are clean and in proper use.

LPA observed required posting inside facility, including: Facility License, Parent’s Rights (PUB393), Emergency Disaster Plan (LIC610); Updated Lunch and Snack Menu and Outdoor Space Waiver.

During inspection, LPA reviewed children’s medication stored in each classroom.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm (REFER TO 809C FOR CONT.)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FAMILY DEVELOPMENTAL CENTER (PRESCHOOL)
FACILITY NUMBER: 380505568
VISIT DATE: 01/17/2023
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Admin. 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

Based on today's inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations. Exit interview and report was reviewed with Rosaura Diaz, Co-Education Director, Sueli Nunes and Co-Education Director, Mechele Pruitt, and signature of this form acknowledges receipt of these documents.



This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4