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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001217
Report Date: 10/17/2024
Date Signed: 10/17/2024 01:12:20 PM

Document Has Been Signed on 10/17/2024 01:12 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:TEMPORARY TOT TENDINGFACILITY NUMBER:
414001217
ADMINISTRATOR/
DIRECTOR:		RODRIGUEZ, JADEFACILITY TYPE:
840
ADDRESS:411 OCEANA BLVD., ROOM F1TELEPHONE:
(650) 355-1312
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
10/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Anne QuintanaTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On October 17th, 2024 at approximately 10:20 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with director, Anne Quintana, and explained the purpose of the inspection. Per director facility is in the process of changing licensed facility ownership to Happy Hall Schools.

Facility operates at Ocean Shore Elementary School, Monday to Friday, from 7:00 AM to 6:00 PM. Present during inspection included 0 children with 1 staff member (director). Facility is operating within capacity requirements and ratios at time of LPA's inspection. Facility operates out of one portable classroom (classroom F1). Facility has two licences. Portable #F1 is used by School Age children from 7:00 AM to 6:00 PM. Portable #F2 is used for the preschool age license from 7:00 AM to 6:00 PM.

LPA and director inspected facility, indoors and outdoors, for health and safety hazards. LPA observed classroom to be clean, equipped with age appropriate toys, materials, and furniture. LPA observed electrical outlets to be made inaccessible with outlet covers. LPA also observed covered trash cans in portable classroom. Storage for children's belongings are located inside portable classroom, labeled with each enrolled child's name on it. Per director, school age does not have a designated nap time due to it being a half day program. Facility does not have enrolled children on IMS Plans on date of inspection.

Facility has an implemented fire alarm system. LPA observed a carbon monoxide detector in portable classroom. LPA tested detector in portable F1 which was observed to be working. Classroom has two fully stocked and accessible first aid kits. Facility has a fully charged fire extinguisher in each portable. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in facility staff bathrooms of each portable.

LPA observed children's bathrooms to be clean and in proper working condition. Facility provides snack only. Menus are posted available for authorized representatives to review. Water is available to children indoors and outdoors with children's water bottles.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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: TEMPORARY TOT TENDING
FACILITY NUMBER: 414001217
VISIT DATE: 10/17/2024
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Outdoor area is fully enclosed. Outdoor area has age appropriate toys and materials that were in working condition LPA noticed padding under children's structure.

Children are signed in and out of facility through one core app system. Children are signed out by parents with the usage of a 4-digit pin. Facility has license documentation and information properly posted and available for review in main entrance of facility. Facility conducts disaster drills at least once every six months. Last conducted disaster drill was on 9/15/2024.

LPA reviewed 5 children's files and 5 staff files. Children's files were complete with a record of emergency identification information on file. Director has a valid CPR/First Aid certificate that will expire 1/2025. Mandated Reporter Training Certificates are also on file for each staff.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completed certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Director 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.

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/inspection-process.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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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: TEMPORARY TOT TENDING
FACILITY NUMBER: 414001217
VISIT DATE: 10/17/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/.

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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Facility failed to test for lead water before January 1st, 2023. Type B deficiency is being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with director, Anne Quintana.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/17/2024 01:12 PM - It Cannot Be Edited


Created By: Janet Gil On 10/17/2024 at 12:45 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: TEMPORARY TOT TENDING
FACILITY NUMBER: 414001217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, 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, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in testing for lead in drinking water before January 1st, 2023 which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2024
Plan of Correction
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Facility tested for lead on 5/10/2023 and have recieved results with no exceedances.
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.
SUPERVISOR'S NAME:Garfield Leung
LICENSING EVALUATOR NAME:Janet Gil
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


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