384004684-4-13-2023-05-CC-CQUO-CQUTFM-20230413144147

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004684
Report Date: 04/13/2023
Date Signed: 04/13/2023 02:41:56 PM

Document Has Been Signed on 04/13/2023 02:41 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:	COW HOLLOW SCHOOL		FACILITY NUMBER:	384004684
ADMINISTRATOR:	CAMPBELL, DARCY		FACILITY TYPE:	850
ADDRESS:	387 MORAGA AVENUE		TELEPHONE:	(415) 921-2328
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94129
CAPACITY: 150	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/13/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Trevor Valentino		TIME COMPLETED:	03:00 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 April 13, 2023 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a schedule pre-licensing inspection. LPA met with applicant, Trevor Valentino, and explained the purpose of the inspection. This is a relocation application. Cow Hollow School is currently licensed with facility 384001621. Application was received February 10, 2023. The applicant is requesting for a preschool program for a capacity of 150 preschool children (2 years to entry into first grade). The facility will operate Monday through Friday 8:00am to 5:30pm. Applicant plans for children to be signed in and out of facility with an electronic signature. Applicant is aware sign in/out records must be made available for department's review. The designated director for the facility will be Darcy Campbell. The facility was inspected, indoors and outdoors, for health and safety hazards and measured to calculate capacity. Indoors: The are 7 classrooms in the facility: Hummingbird, Sparrow, Plover, Sandpiper, Stellar Jay, Robin, and Hawk (Cooper and Red tailed). Facility also includes an art room, health room, laundry room, kitchen, faculty room, multi-purpose area and multiple offices that were not calculated nor included for overall capacity. Hummingbird classroom (younger 2 year olds) was measured for 1,017.82 sq. ft. allowing for a capacity of 29 children. Sparrow classroom (mid 2 year olds) was measured for 1,422.61 sq. ft. allowing for a capacity of 40 children. Plover classroom (mid 2 year olds) was measured for 932.74 sq. ft. allowing for a capacity of 26 children. Sandpiper classroom (older 2 year olds) was measured for 926.37 sq. ft. allowing for a capacity of 26 children. Stellar Jay (3 to 4 year olds) classroom was measured for 1,576.18 sq. ft. allowing for a capacity of 45 children. Robin classroom (3 to 4 year olds) was measured for 1,289.15 sq. ft allowing for a capacity of 36 children. Hawk classroom (4 to 6 year olds) was measured for 1,733.33 sq. ft. allowing for a capacity of 49 children. Total indoor square footage equals 8,898.20 sq. ft. allowing for a total capacity of 254 preschool children. (Continue Report on Page 2...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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: COW HOLLOW SCHOOL	FACILITY NUMBER: 384004684
	VISIT DATE: 04/13/2023

NARRATIVE

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LPA observed classrooms to be clean, appropriately ventilated. Classrooms are equipped with furniture, toys and materials that were observed to be new and in good condition. Classroom furnishings were observed to be safe and age appropriate. Sufficient storage space for children's personal belongings are located either inside or outside the classrooms.

Electrical outlets in classrooms will be made inaccessible with child safety covers. Poisons, cleaning supplies, hazardous materials will be stored, inaccessible behind child safety locked cabinets. Each classroom will be equipped with a first aid kit and carbon monoxide detector. LPA observed multiple fire extinguishers and fire alarm system throughout facility.

Each classroom has a bathroom that includes multiple toilets and sinks. Facility includes 17 toilets and 16 sinks for children's use. Total allowable capacity for toilets is 255 children. Total allowable capacity for sinks is 240 children. Sinks children have access to do not provide water that is warmer than 120 degrees Farenheit.

Program plans to provide napping children with cots. Children's families are to provide sheets and blankets. Per applicant, sheets and blankets will be sent home weekly or as needed. Program does not plan to launder sheets and blankets on site.

Designated isolation area will be located in facility's front office and/or reception area. Facility's discipline policy will be positive reinforcement with a social, constructive approach.

Program plans to provide morning and afternoon snacks only. Lunch will be provided by enrolled children's families. Snacks will be prepared in facility kitchen. Applicant was reminded poisons, cleaning solutions must not be stored with food. Applicant was also reminded children who bring their own meals are to be labeled with each child's individual names. Facility includes multiple water fountains, both indoors and outdoors. Children are to bring their own water bottles that can be refilled at center.
(Continue Report on Page 3...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COW HOLLOW SCHOOL	FACILITY NUMBER: 384004684
	VISIT DATE: 04/13/2023

NARRATIVE

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Medications with children’s individual names and required documentation will be stored in appropriate classroom. Medications that require refrigeration will be stored in a staff refrigerator. This facility plans to provide Incidental Medical Services –
IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

Outdoor: The outdoor area includes three separate areas for preschool children, based on their age ranges: young 2s playground, 2-3 year olds playground and 3 years and up playground. Total outdoor area measures for 21,417 sq ft. allowing for a capacity of 286 children. Entire outdoor area is enclosed with an at least 4 ft. high fence. Outdoor area was observed to be clean. Flooring in outdoor area includes both grass and concrete. Play structures were observed to have resilient padding underneath.

There are additional spaces in outdoor area that program has access to including fully fenced grass area (located near 3 years and up playground), and fully fenced, side yards. Applicant is aware staff are to always supervise children when in outdoor areas.

LPA reviewed with applicant 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 applicant to conduct and document emergency disaster drills at least once every six months.

Applicant 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.
(Continue Report on Page 4...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COW HOLLOW SCHOOL	FACILITY NUMBER: 384004684
	VISIT DATE: 04/13/2023

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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.

During inspection, applicant provided LPA with documents indicated on Notice of Incomplete application (LIC184C).

Prior to recommended licensure, following must be complete:
-Fire clearance.
-Inaccessibility of and/or additional padding of rock on 2-3 year old playground.
-Installation of shade in outdoor area.
-Installation of a carbon monoxide detector in each classroom.
-Installation of child safety locks on gates in outdoor area.
-Posting of licensing documentation.
-Full review of application by LPA.

Applicant understands once facility 384004684 is licensed, license at facility 384001621 will be forfeit. Last day of services at facility 384001621 will be May 5, 2023.

Exit interview conducted and report was reviewed with applicant, Trevor Valentino.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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