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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004747
Report Date: 12/19/2023
Date Signed: 12/19/2023 05:15:45 PM

Document Has Been Signed on 12/19/2023 05:15 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MOLDOVAN ACADEMYFACILITY NUMBER:
384004747
ADMINISTRATOR:NAVARRO, DARLENEFACILITY TYPE:
850
ADDRESS:1650 VALENCIA STREETTELEPHONE:
(707) 337-2874
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 19DATE:
12/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kathleen MoldovanTIME COMPLETED:
05:20 PM
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On 12/19/2023 at 1:30PM., Licensing Program Analysts (LPAs) Luis J. Gomez and Janet Gil met with Licensee, Kathleen Moldovan. Purpose of inspection was explained and was for Unannounced, Case Management Inspection for Increase in Capacity, Room Addition (#4) with Children’s Bathroom. Licensee is also adding an Outdoor Play Space. Per Licensee, toddler program will be in the downstairs classrooms only (Classroom #1 (#5), #2, and #3). Facility has requested to increase their capacity from 22 to 38 children. Included in request is a Toddler Option for 16 children. Present during inspection was the licensee and 6 staff supervising 19 children. Program's day and hours of operation are Monday - Friday, 8:00AM- 6:00PM. LPAs measured facility, and inspected the new indoor and outdoor space.

At 1:45PM., LPAs measured upstairs (#4) classroom. The total useable square footage for the upstairs classroom is 717.658 sq. ft. Total usable square footage divided by 35, equals to 20 children. LPA observed new children’s bathroom, located in classroom #4, was equipped with 1 toilet, 1 sink and 1 urinal. Fixtures tested were in operating conditions. Separate bathroom for staff usage is located on the premises. Total allowable capacity for toilets (3) and sinks (3) is 45 children.



Upstairs classroom (#4) was observed clean, orderly, with age-appropriate playthings. Furniture, and puzzles inspected were in safe condition, with all tall standing furniture properly anchored against the wall. Floor and ground surfaces were clear of obstructions or hazards. LPA observed cubbies available for storage of children's belongings. Fully charged fire extinguishers (2A:10BC) located in hallway. Classroom has a built-in, smoke/ carbon monoxide combination detector. Accessible trash bins and outlets have had coverings installed. First aid kit was reviewed was fully stocked. Classroom has adequate ventilation and lighting. (REFER TO 809C FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MOLDOVAN ACADEMY
FACILITY NUMBER: 384004747
VISIT DATE: 12/19/2023
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(Page 2)
At 2:30PM., LPAs measured the shared, outdoor play space. Outdoor: Total useable square footage of outdoor play yard measures 1190sq ft. Total usable area divided by 75 sq ft allows for a total of 17 children. LPA observed the outdoor play space is completely enclosed. Absorbent material has been installed on ground surface for added safety. Movable play structure was in proper repair. Per Licensee, water services will be readily available with refillable bottles and pitchers.

Per licensee, lunches and snacks will be provided families. LPA reminded licensee to ensure food brought to the facility is properly labelled. Medications will be stored in each classroom. All toxins and other hazardous items will be stored in each classroom inaccessible to children. Isolation of ill children will be in the facility office.

Facility provides Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. For IMS information see Title 22 Regulations sections 101173 and 101226. 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

During inspection, licensee submitted an updated LIC309, LIC500, Waiver Request Letter, Parent Handbook, and Lease Agreement. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MOLDOVAN ACADEMY
FACILITY NUMBER: 384004747
VISIT DATE: 12/19/2023
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(PAGE 3)
Prior to recommendation for approval of facility's increase in capacity to 38 children with Toddler Option for 16 children, licensee must complete the following:
*Obtain fire clearance for request capacity (STD850).
*Remove one (1) urinal from facility operation

>No deficiencies were observed according to CCR, Title 22. Sec.12 Ch. 1.

This report must be available in the facility for public review. Notice of site visit was observed being posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3