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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509670
Report Date: 04/28/2026
Date Signed: 04/28/2026 05:37:13 PM

Document Has Been Signed on 04/28/2026 05:37 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: 77DATE:
04/28/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Michael KoenigTIME VISIT/
INSPECTION COMPLETED:
05:40 PM
NARRATIVE
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On 4/28/2026 at 1:25PM., Licensing Program Analyst, Luis Gomez met with Program Director, Mike Koenig. The purpose of the visit was explained and is for an unannounced, annual-random inspection. The program offers care for school-age children at Highlands Recreation Center. The program utilized the Social Room, Gymnasium, and the Outdoor Sport Court and Playground. Per director, days and hours of operations are Monday, Tuesday, Thursday, and Friday, 12:40pm- 6:00pm and Wednesday, 12:25PM- 6:00pm. Present was the director and 6 staff supervising 77 children. LPA inspected the facility, indoor and outdoor, with director for health and safety hazards.

At 1:45PM., LPA observed the following: The facility was clean and neat, with age-appropriate materials and equipment available for the children. The floors, including carpet and ground surfaces, were clear of any obstructions or hazards.

The walkway, located outside, has several storage hooks available for children’s belongings.

LPA observed classroom were equipped with cabinets and shelving for supplies and staff items. The accessible furniture, materials/ playthings inspected were in good repair, free of sharp corners or splinted edges.

The social room was equipped with tables and chairs for planned activities, had acceptable ventilation, lighting, and a comfortable temperature. The facility has functioning carbon monoxide detector/ smoke combination detector and fully charged fire extinguishers (3A:40BC). The bathrooms were clean and had adequate supplies for children to wash hands.

The food storage/ preparation area was reviewed during inspection. The food items inspected were current and had been properly stored. Per director, food service (Snack) is provided by program for children in care. The detergents, cleaning supplies, and wipes were observed in the off-limit area. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2026
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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Document Has Been Signed on 04/28/2026 05:37 PM - It Cannot Be Edited


Created By: Luis Gomez On 04/28/2026 at 04:14 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: 04/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(b)(2)
Pool Safety
(b) A licensed daycare center with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The swimming pool shall have a second, redundant feature that prevents children in the daycare center from entering the pool area unattended.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 3:00PM., Based on observation and interview, LPA confirmed on-site pool does not have a second feature, preventing children from entering pool area. This poses a potential risk to the health and safety of children in care.
POC Due Date: 05/15/2026
Plan of Correction
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The facility will installed second, redundant drown prevention feature on pool by the due date: 5/15/2026.
The proof of correction will be submitted to the Department via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:
Luis Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2026


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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HIGHLANDS RECREATION CENTER
FACILITY NUMBER: 410509670
VISIT DATE: 04/28/2026
NARRATIVE
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(Page 2)
At 2:25PM., LPA inspected the outdoor play areas (sport court and playgrounds) and swimming pool. The LPA observed playground area was completely enclosed with an available (Anchored) climbing structure. The facility had installed absorbent material (Tanbark) underneath the slides. The Sport court/ black top area was free of trash or rubbish. For accessible drinking water, the center has available water fountains, for children to drink as they wish.

This on-site pool was reviewed during inspection. The pool area was completed enclosed with two self-latching gates to prevent child access. The pool had a body hook on a pole and safety ring (at least 17 inches in diameter).

At 3:00PM., Based on observation and interview, LPA confirmed on-site pool does not have a second feature, preventing children from entering pool area.

The director was advised to inspect and log the pool's drown prevention features and equipment daily. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 3:30PM., LPA review facility records including sample of 3 children’s files and 6 personnel files. The staff files reviewed and included: Declaration to Report Suspected Child Abuse (LIC9108); Proof of Teacher Qualifications; Immunization Record; and Notice of Employee Right (LIC9052).


The staff and director have completed required mandated reporter training course- AB1207.

The children’s files were reviewed included: Identification of Emergency Information; Consent for Medical Treatment; Notification of Parents Rights; Personal Rights; and Admission Agreement.

The director’s current CPR/ 1st aid certification on file, expiring: 6/2026. Per director, facility is conducting emergency disaster (Earthquake and Fire drills) every six months, with last completed on 3/4/2026.

Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed child care 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 verified that the lead testing was completed in accordance with the Written Directives outlined in PIN21-21- CCP.

All required posting were reviewed including the facility included the License Certificate; Parents Rights (PUB393); Personal Rights; Menu (April); Emergency Disaster Plan (LIC610) and CA Seat Belt Safety Laws.

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.)

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

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HIGHLANDS RECREATION CENTER
FACILITY NUMBER: 410509670
VISIT DATE: 04/28/2026
NARRATIVE
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The 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, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations, and cited on LIC809D. An exit interview discussing the facility evaluation report and plan of correction was conducted with Director, Michael Koenig, and signature on this form acknowledges the receipt of these documents.

This report must be made available in facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director was advised, any additional questions/ concerns to contact the San Bruno Regional Office, Mon-Fri, 8:00am-5:00pm, 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: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC809 (FAS) - (06/04)
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