414002756-1-30-2024-05-CC-LGOZ-CZYSCM-20240130124545

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002756
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:45:54 PM

Document Has Been Signed on 01/30/2024 12:45 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:	A+ IMMERSION PRESCHOOL		FACILITY NUMBER:	414002756
ADMINISTRATOR:	SHARON LAU, PRG.DIR.		FACILITY TYPE:	850
ADDRESS:	1501 SOUTH B STREET		TELEPHONE:	(650) 292-0817
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 18	DATE:	01/30/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sharon Lau, Yan Liu		TIME COMPLETED:	12:50 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 1/30/2024 at 9:00AM., Licensing Program Analyst (LPA), Luis Gomez and Teacher, Yan Liu. Purpose of the inspection was explained and was for an Unannounced, Random inspection. The facility is licensed to operate a preschool program. Present during inspection was the lead teacher and two staff supervising 18 children. Director/ Licensee, Sharon Lau arrived during inspection. Children present had been properly signed in by authorized representative. The facility staff have criminal record clearances of file. The childcare program utilizes three classrooms including the Main Building: Front Room (Classroom #1); Back Room (Classroom #2); and 2^nd Building: Classroom #3. Facility also uses the outdoor play area. Program’s days and hours of operation are: Monday through Friday, 7:30AM- 6:00PM. Per director, children care services are provided year-round. LPA inspected facility for health and safety hazards.

At 9:30AM., the following was observed: Classrooms were clean and orderly, with age-appropriate materials available for the children. LPA observed floor and ground surfaces were clear of obstructions or hazards. The off-limit areas were made in accessible with child safety gates and lockable doors. Each classroom had child- sized tables and chairs. Facility was equipped with labelled cubbies for storage of children's belongings. Accessible furniture was free of any sharp corners or splinters. The children’s bathroom, located in classroom #2, was observed clean with fixtures in operating condition.

At 9:40AM., Based on observations, LPA confirmed the toilet tank cover in children’s bathroom was broken. Facility was issued an Advisory Note: Technical Violation (LIC9102TV).

Per director, staff bathroom is located in the 2^nd Building. The activity agenda includes scheduled nap is provided for children. For nap services, facility has stackable cots stored in the facility closet. (REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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 7

Document Has Been Signed on 01/30/2024 12:45 PM - It Cannot Be Edited

Created By: Luis Gomez On 01/30/2024 at 11:06 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: A+ IMMERSION PRESCHOOL	FACILITY NUMBER: 414002756
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 10:10AM., Based on record review, interview, and observations, LPA confirmed facility fixtures, used for drinking water and food preparation, have not been tested for lead exceedance levels. This pose a potential health and safety risk to children in care.
	POC Due Date: 02/16/2024
	Plan of Correction
1 2 3 4	Director will ensure all water outlets, used for water consumption or food preparation, are tested for lead exceedance levels by the due date: 2/16/2024. Proof of correction will be submitted to department via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 01/30/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

Page: 2 of 7

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: A+ IMMERSION PRESCHOOL	FACILITY NUMBER: 414002756
	VISIT DATE: 01/30/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Page 2)
The children’s cots are made from a cleanable plastic material. Per director, napping linens are taken home by families to be washed every week. The facility had adequate ventilation and was a comfortable temperature. Classrooms had sufficient lighting for the children. Classrooms were equipped with testable carbon monoxide detector, smoke detector, telephone service, and fire extinguishers: 2A:10:BC. Per director, the local fire authority makes yearly visits to the center. LPA reviewed the first aid kit during inspection. Per director, diaper changing services are provided by staff. Per director, the diaper changing mat is cleaned and disinfected after each use.

At 9:55AM., LPA inspected the outdoor play area. The outdoor area was completely enclosed with a shaded rest area available with benches for seating. An absorbent turf material had been installed on the ground surface for added safety. Per director, staff review sand box area daily for foreign objects. Per director, water services are provided both inside and outside with refillable cups.

LPA reminded licensee to remove all hazardous plants and broken playthings from outdoor area. Facility was issued an Advisory Note: Technical Violation (LIC9102TV).

At 10:05AM., LPA reviewed facility records including 5 children’s files and 3 personnel files.

At 10:10AM., Based on record review, interview, and observations, LPA confirmed facility fixtures, used for drinking water and food preparation, have not been tested for lead exceedance levels.

LPA referred director/ licensee, Sharon Lau to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

Facility’s personnel files were reviewed and contained the: Teachers Qualifications, Notice of Employee Rights (LIC9052), Personnel Record; Proof of Immunization; and staff's ‘Mandated Reporter Training’ Certifications (AB1207).

Facility’s children’s files were reviewed and contained the: Immunization Records, Identification and Emergency Information (LIC700); Notification of Parent’s Rights (LIC995); Personal Rights (LIC613A); and ‘Physician Report’.

LPA reminded director to ensure all required forms are stored in the facility files.

(REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: A+ IMMERSION PRESCHOOL	FACILITY NUMBER: 414002756
	VISIT DATE: 01/30/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Page 3)
All personnel had their current cardiopulmonary resuscitation / first aid certification on file, expiring on 6/2025.
The required emergency disaster drills are being conducted every six months, with last drill completed on 1/4/2024, properly logged by director.

LPA observed required postings are located near entryway and include the: Facility License; Notification of Parent’s Rights (PUB394); Passenger Safety Law (PUB269); and Emergency Disaster Plan (LIC610).

Per director, food services are not provided by childcare program.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated. (REFER TO 809c, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: A+ IMMERSION PRESCHOOL	FACILITY NUMBER: 414002756
	VISIT DATE: 01/30/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Page 4)
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Chap. 1 Ca. Code of Regulations and cited on 809D. Exit interview, plans for correction, and facility evaluation report was discussed with Director/ Licensee, Sharon Lau. Licensee's signature on this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director was advised any additional questions to call office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

Page: 7 of 7