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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004598
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:38:24 AM

Document Has Been Signed on 02/08/2023 11:38 AM - 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:GOOD SAMARITAN FAMILY RESOURCE CENTERFACILITY NUMBER:
384004598
ADMINISTRATOR:CASTILLO, MELISSAFACILITY TYPE:
850
ADDRESS:2050 FOLSOM STREETTELEPHONE:
(415) 401-4253
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 0DATE:
02/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Melissa CastilloTIME COMPLETED:
11:52 AM
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On February 8, 2023 at 9:00 AM, Licensing Program Analyst (LPA) Sheran Lo met with Director Melissa Castillo today for a pre-licensing inspection. The applicant is requesting 48 children (ages 2 years to entry into first grade). The facility will operate Monday - Friday; 8:00 AM to 5:30 PM. The designated director/site supervisor for the facility is Melissa Castillo. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: There are eight classrooms that will be used for the program and the following square footage was calculated for each room: Room 1- 955.5 sq ft. and Room 2- 1,084 sq ft. Total useable indoor square footage is 2,039.5 sq ft divided by 35 sq ft equals 58.271 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 is storage space for children's personal belongings and cots to be utilized for napping children. Facility will provide sheets to be laundered on site and children's personal beddings will sent home to be laundered weekly. Cots will be cleaned at least weekly or more often if needed. Children will be signed in and out with a electronic tablet 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 sealed inaccessible to children. The program provides two snacks and lunch daily catered by Chefables. Only reusable products will be used for food served by the facility. Facility has dishwasher in the kitchen. Snack foods will be stored in the kitchen separately from any cleaning products or other hazards. Medications will be stored in the health office 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: 02/08/2023
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: GOOD SAMARITAN FAMILY RESOURCE CENTER
FACILITY NUMBER: 384004598
VISIT DATE: 02/08/2023
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There are _7 toilets (105 capacity) and 7 sinks (105 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 bottle filled each morning 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 office and staff bathroom will be used for an ill child.

Outdoor: The outdoor area measures 1,816 sq ft. allowing for a total of 24 children. The outdoor area to be used is enclosed by four building walls located in the middle of the facility and observed to be clean, safe and equipped with toys and equipment for children. Resilient material located under climbing applicable climbing platforms are cushioned. Facility will use rotation schedule for children's use. There will be individual water bottles to allow children access to drinking water outside. Shade for children will be provided by building structures.

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 has been conducted on January 17, 2023 and approved. The requirement for Lead Water Testing was discussed (H&S Code 1597.16). 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.

Facility representative 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.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
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: GOOD SAMARITAN FAMILY RESOURCE CENTER
FACILITY NUMBER: 384004598
VISIT DATE: 02/08/2023
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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) 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

Exit interview conducted and report was reviewed with the facility representative Melissa Castillo.

LPA reviewed with facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Entrance Checklist was provided to the applicant.

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 platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA Lo will recommend licensure of this facility for a capacity of 48 children effective today.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
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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