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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518991
Report Date: 08/23/2024
Date Signed: 08/23/2024 11:17:02 AM

Document Has Been Signed on 08/23/2024 11:17 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SAN MATEO-FOSTER CITY SCHL DIST - NORTH SHOREVIEWFACILITY NUMBER:
410518991
ADMINISTRATOR/
DIRECTOR:		CRISTINA HALEYFACILITY TYPE:
850
ADDRESS:1301 CYPRESS AVENUETELEPHONE:
(650) 312-7588
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY: 24TOTAL ENROLLED CHILDREN: 17CENSUS: 0DATE:
08/23/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Cristina Haley and Hiromi MeadTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
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On August 23, 2024 at approximately 8:35am, Licensing Program Analysts (LPAs) Catrina Quimbo and Zeynep Basak, conducted an unannounced, case management visit. LPAs met with principal, Cristina Haley, and lead teacher, Hiromi Mead, and explained the purpose of the visit. No enrolled children were present during visit.

Preschool program operates at North Shoreview Montessori Elementary School in classroom #20. Preschool requested to add classroom #1 and outdoor area (with play structure) located directly outside classroom #1. Fire clearance was obtained August 6, 2024.

Hours of operation are Monday through Friday 8:30am to 3:00pm. LPAs inspected classroom #1 and outdoor area for health and safety hazards, and measured spaces to verify capacity.

Indoors: Classroom #1 was measured for 827.76 sq. ft. allowing for a capacity of 23 children. Preschool program operates as a Montessori program. LPAs observed classroom to include a variety of Montessori materials that are in good condition. Classroom is separated into sections for sensorial, language, practical life, and motor development. LPAs observed classroom be clean, equipped with age appropriate materials. Flooring in classroom includes a new carpet, free of stains.

Classroom is equipped with a fire alarm implemented by school district. Per principal, smoke detectors in classroom are dual smoke/carbon monoxide detectors. LPAs advised a separate carbon monoxide detector to be installed. Classroom is equipped with an emergency backpack, emergency materials and a fully stocked first aid kit. LPAs observed garbage bins in classroom to have a tight fitting lid.

Classroom also includes an exclusive restroom for preschool children's use with two toilets and two sinks. There is also an additional sink in the classroom accessible to children. Total allowable capacity for sinks is 45 children. Total allowable capacity for toilets is 30 children.
(Continue Report on Page 2...)
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SAN MATEO-FOSTER CITY SCHL DIST - NORTH SHOREVIEW
FACILITY NUMBER: 410518991
VISIT DATE: 08/23/2024
NARRATIVE
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Outdoors: The outdoor area to be added is located directly outside classroom #1. Outdoor area is entirely fenced and enclosed with an at least 4 ft. high fence. There is a play structure that is in good condition and with resilient padding underneath. LPAs did not observe any pools, spas or bodies of water on site.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). Program completed lead water testing March 2023.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Drinking water is available to children with accessible drinking fountains on site.

Facility was issued a Type B citation for completing lead testing after deadline. Facility completed lead water testing March 2023. Lead water results showed fixtures tested to be below 5.5 ppb threshold. Deficiency was cleared during visit.

LPAs will approve for a capacity of 23 preschool children in classroom #1, effective today's date. LPAs will also approve of outdoor area located outside classroom #1, effective today's date.

Principal to submit an updated Application for Childcare License (LIC200A) with a wet signature, updated Designation of Facility Responsibility (LIC308) with a wet signature and an updated facility sketch (LIC999) for outdoor area.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were also provided during visit.

Exit interview conducted and report was reviewed with facility representative, Cristina Haley.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/23/2024 11:17 AM - It Cannot Be Edited


Created By: Catrina Quimbo On 08/23/2024 at 10:56 AM
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: SAN MATEO-FOSTER CITY SCHL DIST - NORTH SHOREVIEW
FACILITY NUMBER: 410518991

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2024
Section Cited
HSC
1597.16(a)(1)

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HSC 1597.16(a)(1) A licensed child day care center... that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023...

This requirement is not met as evidenced by:
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Facility completed lead water testing March 2023. Lead testing results are within the 5.5 ppb threshold. Deficiency cleared during visit.
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Based on interview and record review, the licensee did not comply with the section cited above by not completing lead testing by January 1, 2023 in accordance to written directives, which poses a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Marie Rodriguez
LICENSING EVALUATOR NAME:Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024


LIC809 (FAS) - (06/04)
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