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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001561
Report Date: 03/29/2022
Date Signed: 03/29/2022 03:34:23 PM

Document Has Been Signed on 03/29/2022 03:34 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:HIGHLANDS RECREATION DISTRICTFACILITY NUMBER:
414001561
ADMINISTRATOR:NATALEE GARAY-ESPINALFACILITY TYPE:
850
ADDRESS:1851 LEXINGTON AVENUETELEPHONE:
(650) 341-4251
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 38TOTAL ENROLLED CHILDREN: 34CENSUS: 22DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kristen Lein TIME COMPLETED:
03:45 PM
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On 3/29/2022 at 11:00A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Assistant Director, Kristen Lein. Purpose of the inspection was explained and was for an unannounced, Annual/ Random inspection. Present was the Assistant Director and 5 staff supervising 22 children. All children present had been signed in. Preschool program utilizes two rooms: Chameleon Classroom, Tiger Classroom and one, shared, Outdoor Play Space. Days and Hours of operation are Monday- Friday 7:30am- 6:00pm. Preschool Program operates year around. LPA inspected facility, indoors and outdoors, with assistant director for health and safety hazards.

At 11:15 A.M., the following was observed: Classrooms inspected were clean and orderly with age-appropriate books, blocks and art supplies available for the children. Floor and ground surfaces leading to the exits were free of any obstructions. Children’s furniture and playthings inspected were in good repair. For storage, classrooms were equipped with individual cubbies for children's belongings. Each classroom had several child sized tables and chairs for snack and activities. For napping services, napping mats are stored in each classroom and labelled with pertaining child’s name. Per assistant director, napping supplies and sheets are sent home weekly to be washed by families.

At 11:30A.M., Based on observation and interviews, LPA confirmed safety gate, blocking off-limit kitchen area has been removed. During inspection, Advisory Note: Technical Violation (LIC9102) was issued. Classroom were the proper temperature, with ventilation and lighting. The shared children’s bathroom was reviewed during inspection (4 toilets and 3 sinks) Bathroom fixtures tested were in proper operating condition. Children's bathrooms had adequate supplies available. Staff bathroom was located outside the main office. Cleaning detergents, supplies, spray bottles and all other toxins were made inaccessible, stored in facility kitchen. Accessible outlets had been properly covered. LPA reminded assistant director to ensure all trash bins have tight-fitting covers installed. Facility had telephone service, smoke detector, carbon monoxide detector and fire extinguishers (3A:40BC). Facility’s first aid kit was reviewed during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: HIGHLANDS RECREATION DISTRICT
FACILITY NUMBER: 414001561
VISIT DATE: 03/29/2022
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(Page 2)

At 11:55A.M., LPA inspected facility’s outdoor play area. Area was completely enclosed with tall fencing and was free of debris. Outdoor playthings and tricycles were inspected were in good repair. Sand box was free of any observable hazards.

For water services, children water bottles had been properly labelled and located on a moveable carrier. Per assistant director, children’s water bottles are refilled by staff from a non-contained source. Climbing structure was properly anchored and a shaded rest area was also accessible to day-care children. Tanbark covers the ground area for added fall safety.

At 12:15P.M., LPA review the facility records including 10 children's files and 6 personnel files. Facility files reviewed included staff’s Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), Required Transcripts and Notice of Employee Rights (LIC9052).

LPA reminded assistant director to ensure all staff's proof of immunization are stored in the facility files. All staff present had their current mandated reporter training certification on file (AB1207).

Children's files reviewed were complete. Forms present included the children's Health History (LIC702), Identification of Emergency Information (LIC700), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995) and Immunization Records.

Staff had their current CPR/ First Aid certification on file, expiring on 6/2022. Per assistant director, required emergency drills are conducts every six months, with the last drill done on 2/2/2022. LPA reminded assistant director to ensure disaster drills are properly documented.

Per assistant director, families provide child lunches and the facility offers daily snack service. LPA reminded director to ensure container brought from home are properly labelled with the child’s name. Facility kitchen was reviewed by LPA during inspection.

All required posting are posted outside in the facility hallway and included the facility’s License, Notification of Parents Rights (PUB393), and Updated Emergency Disaster Plan (LIC610).

LPA reminded assistant director to ensure snack schedule is posted and updated for families at least one week in advance. During inspection, LPA reviewed children’s medication and IMS plans on file.

Assistant 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HIGHLANDS RECREATION DISTRICT
FACILITY NUMBER: 414001561
VISIT DATE: 03/29/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on today's inspection, no deficiencies were observed in the areas evaluated, according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Assistant Director, Kristen Lein and her signature of this form acknowledges receipt of these documents.



The 'Notice of Site Visit' form was provided and must remain posted for 30 days.

This report and rights to comment were discussed. This report must be available in the facility for public review. For additional questions, facility was advised to contact the Community Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4