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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509670
Report Date: 10/27/2022
Date Signed: 10/27/2022 03:30:33 PM

Document Has Been Signed on 10/27/2022 03:30 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 CENTERFACILITY NUMBER:
410509670
ADMINISTRATOR:KOENIG, MICHAELFACILITY TYPE:
840
ADDRESS:1851 LEXINGTON AVENUETELEPHONE:
(650) 341-4251
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 86TOTAL ENROLLED CHILDREN: 86CENSUS: 23DATE:
10/27/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mike Koenig TIME COMPLETED:
03:40 PM
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On 10/27/2022 at 2:05PM., Licensing Program Analyst (LPA) Luis J. Gomez met with Lead Teacher, Michael Murphy. Purpose of the inspection was explained and was for an unannounced; Plan of Correction inspection. Director, Mike Koenig arrived during inspection. Present was the director and three staff supervising and 21 children. Children present had been properly signed in. LPA inspected facility, inside and outside, for health and safety hazards.

During today’s inspection, LPA performed site observations and interviewed director.

At 2:20PM., LPA observed the following: Insect screens have been installed on entry door to Social Room (classroom #1). Insect traps have been attached to social room ceiling, and is inaccessible to day-care children. Classroom was observed free of hazards or dangerous conditions. Per director, he plans to change insect traps regularly.

Deficiencies from 9/28/2022, are cleared and ‘Cleared Plan of Correction Letter’ was issued.

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, Mike Koenig, and signature of this form acknowledges receipt of these documents.

LPA was unable to print facility evaluation report during inspection. Copy of report will be sent to director via email.

This report must be available in the facility for public review. Notice was provided and must remain posted for 30 days. Director was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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