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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004095
Report Date: 07/21/2022
Date Signed: 07/21/2022 04:36:49 PM

Document Has Been Signed on 07/21/2022 04:36 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:NATIVITY SCHOOLFACILITY NUMBER:
414004095
ADMINISTRATOR:VLAD, LAURAFACILITY TYPE:
850
ADDRESS:1250 LAUREL STREETTELEPHONE:
(650) 325-7304
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 39TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
07/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director, Laura VladTIME COMPLETED:
12:25 PM
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On July 21st, 2022 at 9:15AM, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, annual, required inspection. LPA met with director, Laura Vlad, and explained the purpose of the inspection. Present in the facility were 2 staff and a total of 13 preschool age children. Director arrived shortly after. All adults working in the facility are fingerprint cleared and associated. Facility is currently operating within teacher to child ratio on this date.

Facility operates on the Nativity Elementary School site in the ‘Pre-Kindergarten’ classroom. Facility operates Mon-Fri, 8am-3pm. Extended hours will be from 3:15p-5:45p, following the school calendar. Facility is currently operating Summer school Mon-Fri from 9am-2:45pm. LPA observed classroom to be clean and equipped with age appropriate toys and materials. During Summer School only a section of the classroom is being used. Storage for children's belongings are located inside the classroom, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system throughout the building as well as multiple fully charged, fire extinguishers. Classroom has a smoke and carbon monoxide detector installed as well as an emergency kits with first aid materials and emergency contact information. Medication is stored appropriately, inaccessible to enrolled children and maintained with proper documentation.

All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility's high shelves. Facility is not offering food services at this time. Water is available to children indoors and outdoors with children's water bottles. Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Play structures have resilient padding. Children are signed in and out of facility by parents' signatures. Facility has license documentation and information properly posted and available for review.

LPA reviewed facility records that included 10 children's records, 3 staff records. LPA observed children's and staff's records to be complete. Teachers have valid CPR certificates. Last emergency drill was conducted 04/2022, however it was not documented. Emergency drills must be conducted at least once every six months and need to be properly logged and documented.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NATIVITY SCHOOL
FACILITY NUMBER: 414004095
VISIT DATE: 07/21/2022
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Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Directors were 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 a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. Licensee does not offer IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

No deficiencies were issued under CCR, Title 22, Division 12.

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

Exit interview conducted and report was reviewed with center director, Laura Vlad.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC809 (FAS) - (06/04)
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