414004018-2-11-2025-05-CC-CQUO-DDSRKW-20250211120614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004018
Report Date: 02/11/2025
Date Signed: 02/11/2025 12:06:20 PM

Document Has Been Signed on 02/11/2025 12:06 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:	HOLY ANGELS PRESCHOOL		FACILITY NUMBER:	414004018
ADMINISTRATOR/ DIRECTOR:	MERLE S LEBAQUIN		FACILITY TYPE:	850
ADDRESS:	20 REINER STREET		TELEPHONE:	(650) 303-1478
CITY:	COLMA	STATE: CA	ZIP CODE:	94014
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 12	CENSUS: 11	DATE:	02/11/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Sister Merle Lebaquin		TIME VISIT/ INSPECTION COMPLETED:	12:15 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 February 11, 2025 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with site supervisor, Sister Merle Lebaquin, and explained the purpose of the visit. Present during LPA's visit included site supervisor, teacher's aide, and 11 preschool age children. Facility is operating within capacity limits and ratio during LPA's visit. Teaching staff present have fingerprint clearance on file. Hours of operation are Monday through Friday 8:00am to 3:00pm. Preschool program operates at Holy Angels Elementary School in Classroom A (main classroom) and Classroom B. Per site supervisor, Classroom B is utilized for lunch time and rainy day use only. Entrance to preschool program is located on Reiner Street. With site supervisor, LPA inspected day care areas, indoors and outdoors, for health and safety hazards. LPA observed classrooms to be clean and organized. LPA observed cleaning solutions and chemicals to be inaccessible to children, stored in classrooms' high shelves. There are a variety of toys, materials and furniture in classrooms that are age appropriate and in good condition. Per site supervisor, toys and materials are sanitized weekly or bi-weekly. LPA observed garbage bin in classroom to have a tight fitting lid. Flooring in the classroom includes carpet that is clean and free of stains. Per site supervisor, carpet is vacuumed daily and shampooed once a year. Storage for children's belongings are located outside the classroom, appropriately labeled with children's individual names. LPA observed children's cubbies to also store napping sheets for napping children. Sheets and blankets are provided by children's families. LPA observed sheets to be wrapped in each child's cubby, so they are not touching other materials. Per site supervisor, sheets and blankets are sent home weekly to be laundered. Children nap in Classroom A on cots. Cots are stored in a teacher's area, appropriately stacked. Per site supervisor, cots are sanitized daily, after each use. LPA observed classrooms to be equipped with a fire extinguisher, fire alarm, smoke detectors, emergency backpack and first aid kit. Classroom A includes a carbon monoxide detector. LPA tested carbon monoxide detector, which was observed to be working. (Continue Report on Page 2...)

Marie Rodriguez	TELEPHONE: (650) 266-8800
Catrina Quimbo	TELEPHONE: 650-266-8800
	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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: HOLY ANGELS PRESCHOOL	FACILITY NUMBER: 414004018
	VISIT DATE: 02/11/2025

NARRATIVE

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Children's restroom was observed to be in working condition. Restroom includes appropriate sanitation and toileting equipment for children's use. There are a set of drawers in restroom that stores children's wipes, gloves and extra toileting materials. LPA observed garbage bins in restroom to have a tight fitting lid.

Outdoor area is fully enclosed and fenced. LPA observed outdoor area to have a variety of outdoor toys and materials in good condition. There is a sandbox and sand table in outdoor area. LPA observed both sandbox and sand table to be appropriately covered when not in use. There is a storage area in the outdoor area that is made inaccessible to children. Play structure in outdoor area was observed to be age appropriate with resilient padding underneath. LPA did not observe any pools, spas or bodies of water on site.

Drinking water is available both indoors and outdoors with children's individual water bottles that can be refilled on site through purchased water bottles (if needed). LPA did not observe an accessible drinking fixture inside or outside preschool program areas.

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.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Program does not provide or offer a food service. Children's families provide food that is brought to facility daily and stored in children's cubbies. Per site supervisor, program does not handle food or prepare children's food. Site supervisor submitted a letter of attestation to department November 2023, attesting water fixtures on site are not used for drinking or food preparation. Water fixtures on site are for hand washing only. Letter of attestation was submitted to department past the due date of January 1, 2023.

This facility provides Incidental Medical Services – IMS. 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-carecenters/
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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: HOLY ANGELS PRESCHOOL	FACILITY NUMBER: 414004018
	VISIT DATE: 02/11/2025

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Children are signed into and out of program with their authorized representatives' written signatures. LPA observed children to be appropriately signed in during today's visit. Sign in and out includes the child's individual name and the time they are signed into and out of program. LPA reviewed sign in/out records for month of December 2024, which were appropriately maintained.

LPA reviewed facility records that includes 6 random children's records and teaching staff's records. Children's records include emergency contact information, admission agreements, immunization records. Both staff present have a current Mandated Reporter certification. Site supervisor was reminded Mandated Reporter certification must be renewed every two years by all staff working with children. LPA did not observe Early Childhood Education (ECE) units for teacher's aide present. LPA reminded site supervisor teacher's aide without ECE units is not counted towards teacher to child ratio. A technical assistance was issued.

Site supervisor's CPR/First Aid certification will expire 08/2025. LPA observed a completed Health Screening form (LIC503) for site supervisor, however, did not observe proof of required immunizations (MMR, Tdap and Flu) for either staff present. LPA reminded site supervisor proof of required immunizations must be made available for all teaching staff working with children. A technical violation was issued.

Licensing documents are properly posted and available for review. Emergency disaster drills are conducted and documented at least once every six months. Last disaster drill was conducted 10/17/2024.

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

Facility representative was reminded that all adults 18 and over, 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.

Facility representative 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.

One Type B citation was issued for submitting water attestation to department, past the due date of January 1, 2023. A plan of correction was discussed with site supervisor. Appeal rights were provided.

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

Exit interview conducted and report was reviewed with facility representative, Sister Merle Lebaquin.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/11/2025 12:06 PM - It Cannot Be Edited

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: HOLY ANGELS PRESCHOOL	FACILITY NUMBER: 414004018
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above. Site supervisor submitted attestation to department past January 1, 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/11/2025
	Plan of Correction
1 2 3 4	Site supervisor submitted a letter of attestation to department November 2023, past January 1, 2023 due date. Letter attests that no water fixture in preschool program is used for drinking or food preparation, preschool children are responsible for bringing their own water bottles, snacks and lunch from home. Store bought water bottles are on site if children need to refill water bottles. Attestation is currently pending management approval.

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.

Marie Rodriguez	TELEPHONE: (650) 266-8800
Catrina Quimbo	TELEPHONE: 650-266-8800
	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC809 (FAS) - (06/04)

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