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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509670
Report Date: 04/16/2025
Date Signed: 04/16/2025 05:09:23 PM

Document Has Been Signed on 04/16/2025 05:09 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 CENTERFACILITY NUMBER:
410509670
ADMINISTRATOR/
DIRECTOR:		KOENIG, MICHAELFACILITY TYPE:
840
ADDRESS:1851 LEXINGTON AVENUETELEPHONE:
(650) 341-4251
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 86TOTAL ENROLLED CHILDREN: 86CENSUS: 75DATE:
04/16/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Mike KoenigTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On 4/16/2025 at 2:05PM., Licensing Program Analysts, Luis Gomez and Nicole Tran met with Program Director, Mike Koenig. The purpose of the visit was explained and is for an unannounced, annual random inspection. Facility is licensed to operate an after-school childcare program. Program is utilizing one classroom and several on site areas including the: Social Room; Gymnasium; and the Outdoor Play Areas. Days and hours of operation: Monday, Tuesday, Thursday, Friday: 2:45pm- 6:00pm and Wednesday, 12:30pm- 6:00pm. Present was the director and 6 staff supervising 75 children. LPAs inspected the facility for health and safety hazards.

At 2:15PM., LPAs observed the following: Facility was clean, neat with age-appropriate materials and supplies available for the children. Facility walkways, floors, and ground surfaces were clear of obstructions or hazards. Storage hangers were available outside for children’s belongings. Equipment and items inspected including books, enrichment supplies, and craft items were in good repair.

The social room had tables and chairs, scaled to the appropriate size. Accessible children's furniture were free of any defects. The children’s bathroom was maintained clean, with adequate supplies for hand washing. Fixtures tested were in operating condition.

Facility had acceptable ventilation and lighting. 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).

The food preparation/ storage area was reviewed during inspection. Food inspected was current and has been properly stored. Areas of free of liter, vermin, or rubbish. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HIGHLANDS RECREATION CENTER
FACILITY NUMBER: 410509670
VISIT DATE: 04/16/2025
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(PAGE 2)
LPAs inspected the outdoor play area including children's playground and basketball courts. playground was enclosed with climbing structure properly anchored. Absorbent material (Tanbark) had been installed for added safety.

This facility on-site pool was reviewed by LPA's during inspection. The pool area was completed enclosed with two self-latching gates installed to prevent child access. LPAs observed pool area had a body hook on a pole, and safety ring, at least 17 inches in diameter. Per pool director, pool areas safety gates and features to prevent access is inspected and logged daily.

Facility had drinking water from accessible water fountains, for children to drink as they wish.

At 3:20PM LPAs review facility records including a sample of 5 children’s files and 6 personnel files.


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).

LPAs reminded director to ensure staff’s proof of immunization/ health screenings are stored in the facility records.

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/ 1st aid certification on file, expiring: 6/2026. LPAs reminded facility to be conducting emergency disaster drills every six months, with last on done one on: 1/16/2025.

The required postings in facility, including the Facility License; Notification of Parents Rights (PUB393); Emergency Disaster Plan (LIC610); Passenger Safety Law; and Updated Snack Menu. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
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: 04/16/2025
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(PAGE 3)
Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed childcare centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test. LPA has verified lead testing procedure had been completed in accordance with the Written Directives outlined in PIN 21-21- CCP.

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/.

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today’s inspection, no deficiencies were cited in areas evaluated according to the Title 22 Division 12, chap 1. Exit interview and evaluation report 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

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4