410509670-1-24-2024-05-CC-LGOZ-CZT3Z3-20240124174052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410509670
Report Date: 01/24/2024
Date Signed: 01/24/2024 05:40:58 PM

Document Has Been Signed on 01/24/2024 05:40 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:	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: 72	DATE:	01/24/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Mike Koenig		TIME COMPLETED:	05:45 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 1/24/2024 at 2:40PM., Licensing Program Analyst, Luis J. Gomez met with Program Director, Mike Koenig. The purpose of the visit was explained and is for an unannounced, annual random inspection. Childcare program is licensed to operate after-school care. Program is utilizing one classroom: Social Room, Gymnasium, and the Outdoor Play Area. Days and hours of operation: Monday, Tuesday, Thursday, Friday: 2:45pm- 6:00pm and Wednesdays, 12:30pm- 6:00pm. Present was the director and 9 staff supervising 72 children. LPA inspected the facility for health and safety hazards.

At 2:50PM., LPA observed the following: Facility was clean and orderly, with age-appropriate materials available for the children. Facility was equipped with books, art supplies, and craft items for scheduled enrichment. Facility had tables and chairs, and accessible furniture was free of defect. The children’s bathroom was maintained clean, with adequate supplies for hand washing. Bathroom fixtures tested were in operating condition.

The social room had acceptable ventilation and lighting. Storage hooks are available for children’s belongings. Facility's disinfectants, cleaning solutions, poisons and other items that could pose a danger, had been stored in the off-limit areas. Facility had functioning Smoke/ Carbon Monoxide Combination Detector; and fully charged fire extinguishers (2A10BC).

LPA inspected the outdoor play area, including the playground and basketball courts. Area was enclosed with plaything in good repair. The climbing structure had been properly anchored, with absorbent material installed for added safety. Water is readily available for children with use of accessible fountains.

(REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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

Document Has Been Signed on 01/24/2024 05:40 PM - It Cannot Be Edited

Created By: Luis Gomez On 01/24/2024 at 04:43 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: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 3:55PM., Based on record review, LPA confirmed facility's fixtures, used for drinking water/ food preparation, have not been tested for lead contamination levels. This poses a potential health and safety risk to children in care.
	POC Due Date: 02/12/2024
	Plan of Correction
1 2 3 4	Director will ensure water fixtures, used for ingestion or food preparation, is tested for lead contamination levels by the due date: 2/12/2024. Proof of correction will be submitted 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:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Luis Gomez

LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: HIGHLANDS RECREATION CENTER	FACILITY NUMBER: 410509670
	VISIT DATE: 01/24/2024

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

(Page 2)
At 3:50PM LPA review facility records including 4 children’s files and 9 personnel files.

At 3:55PM., Based on record review, LPA confirmed facility's fixtures, used for drinking water/ food preparation, have not been tested for lead contamination levels. Per director, lead levels have been tested, however, results have not been sent to State's Water Board.

Facility’s staff files reviewed and included: Declaration to Report Suspected Child Abuse (LIC9108); Proof of Qualifications; ‘Mandated Reporter Training’ certifications (AB1207); and Notice of Employee Right (LIC9052)
LPA reminded director to ensure staff’s proof of immunization are stored in the facility files.

Facility’s children’s files were reviewed included: Identification of Emergency Information; Consent for Medical Treatment; Personal Rights; and Notification of Parent’s Rights.

Present staff members had their current CPR/ 1^st aid certification on file, expiring: 7/2024. LPA reminded facility to be conducting emergency disaster drills every six months, with last on done one on: 10/17/2023.

The required postings in facility, including the Facility License; Notification of Parents Rights (PUB393); Emergency Disaster Plan (LIC610); and Updated Snack Menu.

For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

(REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HIGHLANDS RECREATION CENTER	FACILITY NUMBER: 410509670
	VISIT DATE: 01/24/2024

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

(Page 3)
Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

LPA referred director, Mike Koenig to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

Based on today’s inspection, deficiencies were observed in areas evaluated according to the Title 22 Division 12 of Ca. Code of Regulations and listed on the 809D pages. Exit interview, evaluation report, plan of correction and appeal rights was discussed with director, Mike Koenig. Director’s signature of this form acknowledges the receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director was advised any additional questions to call office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4