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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004245
Report Date: 02/08/2023
Date Signed: 02/08/2023 12:05:42 PM


Document Has Been Signed on 02/08/2023 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:ST. STEPHEN PRESCHOOLFACILITY NUMBER:
384004245
ADMINISTRATOR:KERRY O'SHAUGHNESSYFACILITY TYPE:
850
ADDRESS:473 EUCALYPTUS DRIVETELEPHONE:
(415) 682-2142
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY:36CENSUS: 28DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Kerry O'shaughnessyTIME COMPLETED:
12:15 PM
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 On February 8, 2023., Licensing Program Analyst (LPA) Van met with Director Kerry O'Shaughnessy for an unannounced annual random inspection. The purpose of the inspection was explained, and the Director granted entry to the facility. This facility is a preschool program that operates in St. Stephen's Catholic School. The preschool runs in three classrooms, the Red Cubs, Blue Cubs, and Gold Cubs. Five teachers and the Site Director supervise 28 children today. The facility complies with the staff-children ratios today. Days and hours of operations are from Monday to Thursday between 8:00 AM – 5:50 PM, and Friday is 8:00 AM – 5:00 PM.
LPA toured and inspected the physical plant with the Director for any potential health and safety hazards. LPA observed that the facility has a manual sign-in and out with signatures of parents/authorized representatives; all signatures matched the number of children present. The facility is in good repair and has proper temperature and ventilation. Classrooms have age-appropriate toys and learning materials. The furniture appears steady and in good repair. The facility has carbon monoxide & centralized smoke detectors, fully charged fire extinguishers, and working telephones. LPA observed that each child has their cubbies available. Emergency supplies are stored in locked storage. First aid supplies are fully stocked and available for children's use. Sleeping cots are appropriately stored. Per Director, The Center does not provide Incidental Medical Services and does not have medicine or medication stored at school. All toilets and handwashing sinks are in good working condition with proper sanitation. LPA observed no bodies of water on the premises. The outdoor play area is completely fenced, clean, and in good repair. Outdoor play structures are age-appropriate, in good condition, and free of loose parts. Climbing structures are securely anchored.
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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: ST. STEPHEN PRESCHOOL
FACILITY NUMBER: 384004245
VISIT DATE: 02/08/2023
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 The facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, Emergency Disaster Plan, and Daily activities). Per the Director, the Center provides children with snacks and brings their lunch. The menu is observed posted. The food preparation area is adequately equipped, clean, and free of hazards. Children bring their water bottles. The Center also has water pitchers readily available for children to refill. All storage containers for solid waste within the Center have a proper tight-fitting cover.
Children's records and personnel records were reviewed during the inspection. Records review showed the facility has records of each child's authorized representative's names, addresses, and telephone numbers. In addition, each child's immunization record, medical assessment, and admission agreement can be located in each child's file. Staff records indicate that all staff or individuals requiring caregiver background checks have received criminal records and child abuse index clearances or exemptions. Multiple staff members have a record of valid CPR. All staff maintained immunization records. LPA reviewed the educational qualification of the staff, and all staff had the required ECE units. The Director stated that the Center conducts fire and earthquakes monthly; the last drill was on 01/10/2023.
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 the 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.
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. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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: ST. STEPHEN PRESCHOOL
FACILITY NUMBER: 384004245
VISIT DATE: 02/08/2023
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 The Director was informed about Mandated Reporter training. In addition to AB1207 training required to complete every two years by the Licensee and all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticide training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

During the inspection, LPA requested the following document be sent to the Licensing office by February 22, 2023, to complete the annual inspection.
1. an up-to-date Emergency Disaster Plan (LIC 610)
2. Personnel Report (LIC 500)

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Director, Kerry O'Shaughnessy. Today's report and notice of the site visit were provided to the Director. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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