414003031-8-31-2026-05-CC-LGOZ-DXGSGL-20260831135207

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414003031
Report Date: 08/31/2026
Date Signed: 08/31/2026 01:52:35 PM

Document Has Been Signed on 08/31/2026 01:52 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:	IHSD, INC-LAKEWOOD CDC (PS)		FACILITY NUMBER:	414003031
ADMINISTRATOR/ DIRECTOR:	FERNANDEZ, JOHN		FACILITY TYPE:	850
ADDRESS:	65 TOWER ROAD		TELEPHONE:	(650) 578-3440
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 39	DATE:	08/31/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:50 AM
MET WITH:	John Fernandez		TIME VISIT/ INSPECTION COMPLETED:	02:00 PM

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On 8/31/2026 at 8:50AM., Licensing Program Analyst (LPA), Luis Gomez met with Director, John Fernandez. The purpose of today's visit was explained and was for an unannounced, annual-random inspection. Present was Director and 6 staff supervising 39 children. This is a licensed preschool program located in the San Mateo County Office of Education Building. The childcare utilizes two classrooms and two shared outdoor play areas. Approved waiver for group commingling were observed posted in facility. The classrooms area are: Room #5, (3- 5 year old) and Room #7 (3- 5 year old). The outdoor play areas included the: #1, Main Yard; #2, Secondary Yard. The days and hours of operation are Monday- Friday 8:00AM- 4:00PM. Per Director, the preschool program operates on a 10- month calendar. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:20AM., LPA observed the following: The classroom was neat and orderly, with age-appropriate materials available for the children. Each classroom had been divided into separate activity areas including the dramatic play, reading areas, and multiple subject space. The floors, including carpets area and other ground surface were clear of obstructions or hazards. The accessible furniture, and playthings inspected were in good repair. The furniture was observed free of sharp corners or splintered edges. LPA observed several storage cubbies available for the children’s belongings.

9:40AM., Based on observation, LPA confirmed dirt and debris stains on carpet inside classroom #7. Advisory note: Technical Violation (LIC9102TV) was issued.

The classrooms had several tables/ chairs, scaled to the appropriate size. For the nap/ schedule rest, foldable mats and cots were available inside classrooms. Per director, napping supplies (blankets) are taken home weekly by families to be washed and returned. Per director, the linens are washed onsite weekly. The children’s bathroom was maintained clean with liquid soap and paper towels available for hand washing. The LPA observed changing table for staff use as needed. Per director, diaper are disposed in nearby solid waste bin.

LPA reminded director that all accessible trash bin lids need regular cleaning to avoid build-up or food and other debris. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 9:30AM., Based on observation, LPA confirmed cleaning detergent/ spray bottles stored in food preparation, on classroom #5 microwave unit. During visit, director removed and secured detergents and spray bottles inside a locked cabinet. Advisory Note: Technical Violation was issued.

The classrooms had adequate ventilation, were well lit and maintained at a comfortable temperature for the children. The classrooms had a functioning telephone service (Cell phone), testable carbon monoxide, and smoke combination detector (built-into building); and fire extinguisher size, 2A10BC. (REFER TO 809C, FOR CONT.)

Marie Rodriguez
Luis Gomez
	DATE: 08/31/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: IHSD, INC-LAKEWOOD CDC (PS)	FACILITY NUMBER: 414003031
	VISIT DATE: 08/31/2026

NARRATIVE

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(Page 2)
At 9:50AM., LPA inspected both outside play areas: Primary and Secondary Play yards. The outside areas were completely enclosed with tall fencing. The LPA observed absorbent material (rubber padding) installed underneath the anchored climbing structure (Primary Play yard).

For water services, water cups were available for children to drink as they wish. Per director, the children’s water jugs are refilled from non-contaminated fixtures.

At 10:25AM., LPA reviewed facility records including sample of 5 children’s files and 6 personnel files. Per director, organization uses both Department and Internal Forms to gather client information.

The staff files contained the: Notice of Employee Rights (LIC9052); Proof of Immunization; Acknowledgement to Report Suspected Child Abuse (LIC9108); Teacher Qualification; and Personnel Record (LIC501).

The children’s files were reviewed and included the: Consent for Medical Treatment; Notification of Parents Rights (LIC995A); Identification of Emergency Information; Immunization Record; and Personal Right Form (LIC613A).

The director’s cardiopulmonary resuscitation and pediatric first aid certification was current, expiring on: 3/2028. According to written log with school-wide emergency disaster drills (Earthquake drill) was completed on: 8/26/ 2026.

The required forms had been viably posted and included the: License Certificate; Notification of Parents Rights (LIC995A); Personal Rights Form; and the California Seat Belt Safety Laws; and Menu (August 2026). (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/31/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2026

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: IHSD, INC-LAKEWOOD CDC (PS)	FACILITY NUMBER: 414003031
	VISIT DATE: 08/31/2026

NARRATIVE

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(PAGE 3)
Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed childcare centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPA has verified that lead testing procedure was completed in accordance with the Written Directives outlined in PIN 21-21- CCP.

This facility provides Incidental Medical Services – IMS at this time. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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/.

The director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/31/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2026

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: IHSD, INC-LAKEWOOD CDC (PS)	FACILITY NUMBER: 414003031
	VISIT DATE: 08/31/2026

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(PAGE 4)
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Based on today's inspection, no deficiencies were cited in the areas evaluated, according to Title 22, Division 12, Chap. 1 Ca. Health and Safety Code of Regulations. An exit interview was completed, including a review of facility evaluation report (FER) with Director, John Fernandez. The signature of this form acknowledges receipt of these documents.

This report and rights to comment were discussed. This report must be available in the facility file for public review. The Notice of site visit was provided and must remain posted for 30 days. The staff was advised for additional questions to contact the San Bruno Regional Office, M-F, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/31/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2026

LIC809 (FAS) - (06/04)

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