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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001561
Report Date: 10/24/2023
Date Signed: 10/24/2023 02:33:30 PM

Document Has Been Signed on 10/24/2023 02:33 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 DISTRICTFACILITY NUMBER:
414001561
ADMINISTRATOR:LEIN, KRISTENFACILITY TYPE:
850
ADDRESS:1851 LEXINGTON AVENUETELEPHONE:
(650) 341-4251
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 24DATE:
10/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Linda Friedlin TIME COMPLETED:
02:40 PM
NARRATIVE
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On 10/24/2023 at 8:55AM. Licensing Program Analyst (LPA) Luis J. Gomez met with Assistant Director, Stacy Ahlf for compliant inspection. Purpose of this report is case management to cite for deficiencies observed during complaint inspection. Present was the director, and 9 staff supervising 24 children. LPA inspected facility, indoors and outdoors, for health and safety hazards.

During inspection, LPA interviewed facility staff, observations, and reviewed facility records.

At 9:00AM., Based on observations and interviews, LPA confirmed accessible cleaning solution, spray bottle, in the Tiger classroom.

Based on today’s inspection, deficiencies were observed in the areas evacuated according the Title 22 Division 12 of Ca. Code of Regulations and cited on the 809D. An exit interview, appeal rights, and plan of correction was discussed with Director, Linda Friedlin. A copy of this report with the appeal rights was provided, and signature of this form acknowledges the receipt of these documents.

Report was reviewed with Director, Linda Friedlin. Notice of site visit was provided and shall remain posted for 30 days.

LPA unable to print report during inspection. Copy of report will be sent to facility.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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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Document Has Been Signed on 10/24/2023 02:33 PM - It Cannot Be Edited


Created By: Luis Gomez On 10/24/2023 at 01:34 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 DISTRICT
FACILITY NUMBER: 414001561

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101238(g)

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101238(g) Building and Grounds:
Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement was not met as evidenced by:
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Cleaning solution, spray bottle was removed during inspection.
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At 9:00AM., Based on observations and interviews, LPA confirmed accessible cleaning solution, spray bottle, in the Tiger classroom. This poses a potential health and safety risk to children 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:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023


LIC809 (FAS) - (06/04)
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