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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518991
Report Date: 12/12/2022
Date Signed: 12/12/2022 11:47:13 AM

Document Has Been Signed on 12/12/2022 11:47 AM - 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:SAN MATEO-FOSTER CITY SCHL DIST - NORTH SHOREVIEWFACILITY NUMBER:
410518991
ADMINISTRATOR:CRISTINA HALEYFACILITY TYPE:
850
ADDRESS:1301 CYPRESS AVENUETELEPHONE:
(650) 312-7588
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 11DATE:
12/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Cristina HaleyTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced annual inspection. LPA met with Lead Teacher Hiromi Mead and explained purpose of inspection. Principal Cristina Haley arrived a short time later. School is a montessori program located in Room 20 inside of North Shoreview Elementary School. Present were the Principal, the lead teacher, a teacher, and 11 children (Pre-K). School is operating within capacity requirements and in compliance with child to staff ratio. Hours of operation are Monday to Friday from 8:30am to 3:00pm.

LPA toured and inspected classroom 20. There are no bodies of water, firearms, or weapons on the premises. Classroom is in good condition with proper temperature and ventilation and are free of any hazards. Furniture in classroom is in good repair. Classroom has age appropriate toys and equipment. There is a fish tank, a hermit crab tank, and a stick bug tank for children's observation. All tanks are covered and inaccessible to children. There is one bathroom in the classroom with one sink and two toilets. There is an additional sink in the classroom with a water fountain that is available for children's use. Bathroom appears to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises. The outdoor play area is fenced for supervision with age appropriate toys and equipment in good condition. Play structure is shared with the Kindergarten class and is in good repair with sufficient cushioning underneath.

All required postings and waiver are posted on the bulletin board by the door of the classroom. School only provides a morning snack. A menu is posted for the month. Food preparation area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. Drinking water is available for children indoor and outdoors. All storage containers for solid waste have a proper lid. All cleaning products, chemicals, and toxins are inaccessible to children.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2022
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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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: SAN MATEO-FOSTER CITY SCHL DIST - NORTH SHOREVIEW
FACILITY NUMBER: 410518991
VISIT DATE: 12/12/2022
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Last emergency drill was conducted in December 2022. Emergency drills are conducted on a monthly basis in conjunction with the school's emergency drill schedule and are properly logged. School has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system, a fully charged fire extinguisher, a smoke and carbon monoxide detector, and a working telephone available on site.

Ten children records reviewed were complete. All children have a record of emergency identification information on file. Two staff records reviewed were complete. All staff have a criminal record clearance on file through the school district. Staff's pediatric first aid/CPR certificates are current.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Principal was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (US DOJ) toll-free ADA Information Line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http:://www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022
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: SAN MATEO-FOSTER CITY SCHL DIST - NORTH SHOREVIEW
FACILITY NUMBER: 410518991
VISIT DATE: 12/12/2022
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LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Facility Representative Cristina Haley.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022
LIC809 (FAS) - (06/04)
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