410500701-9-21-2022-05-CC-MROZ-CJGSC4-20220921134455

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500701
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:45:11 PM

Document Has Been Signed on 09/21/2022 01:45 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:	WOODSIDE PARENTS' NURSERY SCHOOL		FACILITY NUMBER:	410500701
ADMINISTRATOR:	TRUDELL, KAREN		FACILITY TYPE:	850
ADDRESS:	3154 WOODSIDE ROAD		TELEPHONE:	(650) 851-7112
CITY:	WOODSIDE	STATE: CA	ZIP CODE:	94062
CAPACITY: 44	TOTAL ENROLLED CHILDREN: 44	CENSUS: 26	DATE:	09/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Daran Reinholm		TIME COMPLETED:	02:15 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	Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced annual inspection. LPA met with Site Supervisor Daran Reinholm and explained purpose of inspection. Facility is located adjacently to Woodside Village Church. Present at the facility were the Site Supervisor, three teachers, one teacher's assistant, four parent teachers, and 26 preschool children. School is operating within capacity requirements and in compliance with child to staff ratio. Hours of operation are Monday to Friday from 9:00 am to 12:00 pm. LPA inspected the school inside and outside with Site Supervisor for health and safety hazards. There are no bodies of water, firearms, or weapons on the premises. The school is in good repair with proper temperature and ventilation and is free of any hazards. All furniture is in good condition. Classrooms have age appropriate toys and equipment. A first aid kit is available at the school. All cleaning products and toxins are inaccessible to children. Outdoor play area is fenced for supervision. Outdoor toys and equipment are age appropriate and in good condition. Play structures are age appropriate and in good repair. There is adequate cushioning underneath the play structures. License was posted inside the facility office. PUB 269 and PUB 393 were not posted inside the facility. Children provide their own morning snack. Kitchen area is inaccessible to children. Kitchen area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. School has a two bathrooms. One bathroom has two toilets and one sink. Second bathroom has one toilet with the sink right outside the bathroom for use. Bathroom areas appear to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises. Last emergency drill was conducted in March 2022. Emergency drills are conducted at least once every six months and are properly logged. Sign-in/out sheets are done electronically. The school has a complete electronic record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system throughout the center. A carbon monoxide detector and a fully charged fire extinguisher are in each classroom and a working telephone is available on-site.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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 5

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: WOODSIDE PARENTS' NURSERY SCHOOL	FACILITY NUMBER: 410500701
	VISIT DATE: 09/21/2022

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
26
27
28
29
30
31
32

Eleven children records reviewed were complete. All children have a record of emergency identification information on file. Five staff records reviewed were complete. All staff have a criminal record clearance on file. Four parent teacher records reviewed were complete. Parent teachers volunteer once a week. Site Supervisor and one head teacher have current pediatric first aid/CPR certificates on file which expire in September 2024.

Deficiencies cited today under California Code of Regulations, Title 22, Division 12, which follows on LIC 809D.

Facility representative was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available.

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, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (US DOJ) 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.

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.

Facility Representative 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 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: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: WOODSIDE PARENTS' NURSERY SCHOOL	FACILITY NUMBER: 410500701
	VISIT DATE: 09/21/2022

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
26
27
28
29
30
31
32

LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Facility Representative Daran Reinholm.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 09/21/2022 01:45 PM - It Cannot Be Edited

Created By: Marie Rodriguez On 09/21/2022 at 12:18 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WOODSIDE PARENTS' NURSERY SCHOOL	FACILITY NUMBER: 410500701
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101169(d)(18)

Application for License

(18) Evidence that the applicant has posted signs at the entrance to the child care center that provide the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above by not having PUB 269 posted in a publicly accessible place at the facility which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 10/07/2022
	Plan of Correction
1 2 3 4	Facility plans to post PUB 269 on a bulletin board outside of classroom.

Type B

Section Cited

CCR

101218.1(c)

Admission Procedures and Parental and Authorized Representative's Rights

(c) The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above by not posting PUB 393 in a publicly accessible place at the facility which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 10/07/2022
	Plan of Correction
1 2 3 4	Facility plans to post PUB 269 on a bulletin board outside of classroom.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Daniel J Oquendo

LICENSING EVALUATOR NAME:

Marie Rodriguez

LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5