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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500083
Report Date: 07/11/2022
Date Signed: 07/11/2022 12:44:10 PM

Document Has Been Signed on 07/11/2022 12:44 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BUNKER HILL PARENTS PARTICIPATION NURSERY SCHOOLFACILITY NUMBER:
410500083
ADMINISTRATOR:KELLY HANAGAN BOWERFACILITY TYPE:
850
ADDRESS:2145 BUNKER HILL DR, RM. 3-6TELEPHONE:
(650) 349-1581
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
07/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tiffany TeeleTIME COMPLETED:
12:45 PM
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On 7/11/2022 at 8:30AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Tiffany Teele. Purpose of the inspection was explained and was for an unannounced; Annual Random inspection. Facility operates a Parent- Cooperative program. Present was the director and 6 staff supervising 16 children. All children present had been properly signed-in. Facility staff have their criminal record clearance on file. Preschool program utilizes Main Classroom; Activity Room; Dining/ Kitchen Area; and one Outdoor Play Area. Days and hours of operation are Monday- Friday 9:00AM- 4:00PM. Summer Program operates, Monday- Friday 9:00- 12:30PM. Program operates year-round. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 8:50AM., the following was observed: classroom was clean, orderly, and with age-appropriate playthings available for the children. Floor and ground surfaces were free of obstructions. Accessible furniture, toys, and the inside play structure inspected were in proper repair. Classrooms had individual cubbies, located inside and outside, for storage of children's belongings. Classroom had child size tables and chairs. Children’s bathrooms were reviewed during inspection. Fixtures were in operating condition and bathroom had adequate supplies. Staff bathrooms are located in separate area. Classrooms had proper ventilation and lighting. Detergents, cleaning supplies, and all other toxins were made inaccessible. Electrical outlets and trash bins were properly covered. Facility had functioning telephone service, smoke/ carbon monoxide detector combo, and fully charged fire extinguisher; 2A:10BC. First aid kit was review during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BUNKER HILL PARENTS PARTICIPATION NURSERY SCHOOL
FACILITY NUMBER: 410500083
VISIT DATE: 07/11/2022
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(Page 2)
At 9:05AM., LPA inspected the outdoor play area. Outdoor spaces was completely enclosed and equipped with a shaded rest area. Play structures was been anchored. Soft padding had been installed around the play structure to absorb potential falls.

LPA reminded director ensure large sandbox is completely covered at the end of each day. LPA observed water fountain accessible to day-care children.

At 9:40AM., LPA review the facility records including 10 children's files and three personnel files. Facility files reviewed had staff’s: Criminal Record Statements (LIC508); Declaration to Report Suspected Child Abuse (LIC9108); Required Transcripts; Proof of Immunization; and Notice of Employee Rights (LIC9052).

All personnel had their current mandated reporter training certification on file.

Children's files reviewed were complete and included the: Health History (LIC702); Identification of Emergency Information (LIC700); Consent for Medical Treatment (LIC627); Notification of Parent’s Rights (LIC995); and Immunization Records.

Staff present had the Cardiopulmonary Resuscitation/ First Aid certification on file, which expires on 9/19/2022.

At 9:45AM., Based on interview and record review, LPA confirmed facility is had not conducted required emergency disaster drills every six months. Advisory Note: Technical Violation (LIC9102TV) was issued.

Per director, program provides snack during summer session only. LPA reminded director to post menu for food services provided by facility. Inspected were current and properly labelled. LPA reminded director to ensure any container brought from home are labelled with child’s name.

Required posting are posted and included the: Childcare License, Notification of Parents Rights (PUB393), and Emergency Disaster Plan (LIC610). Children's medication was reviewed during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BUNKER HILL PARENTS PARTICIPATION NURSERY SCHOOL
FACILITY NUMBER: 410500083
VISIT DATE: 07/11/2022
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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 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.

Facility's Incidental Medical Service (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

Based on today's inspection, no deficiencies were observed in the areas evaluated, according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Director, Tiffany Teele and signature of this form acknowledges receipt of these documents.



The 'Notice of Site Visit' was provided to director and must remain posted for 30 days.

This report and rights to comment were discussed. This report must be available in the facility for public review. For additional questions, facility was advised to contact the Community Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
LIC809 (FAS) - (06/04)
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