410509670-9-28-2022-05-CC-LGOZ-CJQ2E8-20220928171932

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410509670
Report Date: 09/28/2022
Date Signed: 09/28/2022 05:19:46 PM

Document Has Been Signed on 09/28/2022 05:19 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:	HIGHLANDS RECREATION CENTER		FACILITY NUMBER:	410509670
ADMINISTRATOR:	KOENIG, MICHAEL		FACILITY TYPE:	840
ADDRESS:	1851 LEXINGTON AVENUE		TELEPHONE:	(650) 341-4251
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY: 86	TOTAL ENROLLED CHILDREN: 86	CENSUS:	DATE:	09/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Michael Koeing		TIME COMPLETED:	05:25 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 9/28/2022 at 1:25PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Michael Koenig. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Present was the director and 7 and three staff supervising 69 children. All staff have criminal record clearances on file. Children present have been signed in. After-school program utilizes one classroom (Social Room); Multi-purpose room/ Gym; and two outdoor play areas (Tanbark and Blacktop). Swimming pool is also located on-site. Day and hours of operation are Monday- Friday, 1:00PM- 6:00PM. LPA inspected facility, indoors and outdoors, for health and safety hazards. At 1:40PM., LPA observed the following: Facility was orderly with age-appropriate playthings/ materials available for the children. Accessible furniture and materials inspected were in proper repair. Facility is equipped with labeled cubbies and hangers for children’s belongings. Social room has several tables and chairs for activities. At 2:15PM., Based on interviews and observations, LPA confirmed groups of insects (flies) inside facility’s social room. Children’s bathrooms are clean with adequate supplies. Fixtures tested were operating condition. Staff bathroom is located separate. Social room and Multi-Purpose have acceptable ventilation and lighting. Facility’s food preparation area was reviewed during inspection. Food prep area was made inaccessible with safety gate. Sharp knives and hazards have been made inaccessible. Refrigerator was reviewed during inspection. LPA reminded director to discard all expired liquids and food products. Detergents; cleaning supplies; compounds; and toxins are stored in off-limit areas. Electrical outlets are covered. LPA reminded director to ensure all trash bin have proper coverings installed. Facility had functioning smoke detector and one (fully charged) fire extinguishers; 2A:10BC. LPA advised director to ensure CO detector is testable. Advisory Note: Technical Assistance (LIC9102TA) was issued. First aid kit was reviewed during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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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Document Has Been Signed on 09/28/2022 05:19 PM - It Cannot Be Edited

Created By: Luis Gomez On 09/28/2022 at 04:02 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: HIGHLANDS RECREATION CENTER	FACILITY NUMBER: 410509670
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interviews and observations, LPA confirmed groups of insects (flies) inside facility’s social room. This poses a potential health and safety risk to children in care.
	POC Due Date: 10/07/2022
	Plan of Correction
1 2 3 4	Facility will remove flies from facility's social room by the due date: 10/7/2022. Director will submit proof of correction to the Department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Cindy Interiano

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HIGHLANDS RECREATION CENTER	FACILITY NUMBER: 410509670
	VISIT DATE: 09/28/2022

NARRATIVE

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At 2:20PM., LPA inspected facility’s pool area. Pool is completely enclosed with self-latching gates on both ends. Per director, lifeguard remains on-duty when pool is in use. Per director, covering is placed at the end of each day.

Outdoor play areas (Tanbark and Black top) were reviewed during inspection. Tanbark area is completely enclosed with tall fencing. Available seating and shaded rest is accessible for children. Areas are free of debris or hazardous plants or items. Per director, water services are provided with use of refillable water bottles and/or non-contaminated fixture on-site. LPA reminded facility to ensure all children water bottles are labeled with the corresponding child’s name.

At 2:55AM, LPA reviewed the facility records including seven children’s files and seven personnel files. Staff files reviewed included the: Notice of Employee Rights (LIC9052); Criminal Record Statement; Proof of Qualifications; and Declaration to Report Suspected Child Abuse (LIC9108); and Proof of Required Immunization.

Staff’s ‘Mandated Reporter Training’ certificates (AB1207) are current and stored in the facility files.

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

Staff’s Cardiopulmonary Resuscitation / First Aid certification was current, expiring: 7/15/2024. Disaster drills are conducted in facility with the last drill done on, 6/10/2022, properly logged.

Required forms and posted in facility, including the Childcare License; Notification of Parent’s Rights (PUB393); and Emergency Disaster Plan (LIC610). LPA reminded director to posted food menu for families.

Incidental Medical Services (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
(REFER TO PAGE 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: HIGHLANDS RECREATION CENTER	FACILITY NUMBER: 410509670
	VISIT DATE: 09/28/2022

NARRATIVE

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Based on today's inspection, deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations and cited on 809D. Exit interview, plan of correction, appeal rights and report was reviewed with Director, Michael Koenig and signature of this form acknowledges receipt of these documents.

This report and appeal right and rights were discussed. This report must be available in the facility for public review.

Notice of site visit was provided and must remain posted for 30 days. Any additional questions facility was advised to call the Childcare Regional 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: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

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