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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004114
Report Date: 06/15/2022
Date Signed: 06/15/2022 01:45:39 PM

Document Has Been Signed on 06/15/2022 01:45 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONSFACILITY NUMBER:
414004114
ADMINISTRATOR:JENNY HOBSONFACILITY TYPE:
850
ADDRESS:1311 SO. EL CAMINO REALTELEPHONE:
(650) 340-7241
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 52DATE:
06/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Alexander Baranes, Jenny Hobson TIME COMPLETED:
01:50 PM
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On 6/15/2022 at 8:55AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Staff Member, Alexander Banares. Purpose of the inspection was explained and was for an unannounced; Annual Random inspection. Facility is a combination center with an infant program onsite. Present was 12 staff supervising 52 children. LPA reminded facility to ensure all children are properly signed-in. All adults have their criminal record clearance on file. Site director arrived during inspection. Preschool program utilizes five classrooms: Kinder Preparation (4- 5 year old); Monarch 1 (3 year old); Monarch 2, (4 year old); Butterfly 1 (2 year old); and Butterfly 2 (2 year old). Program shares two outdoor play spaces: Preschool Yard and '2's' Yard. Hours of operation are Monday- Friday 8:30am- 6:00pm. Program operates year-round. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:10AM., the following was observed: classrooms inspected were clean, orderly, and with age-appropriate playthings available for the children. Floor and ground surfaces were free of any obstructions. Furniture and toys inspected were in proper repair. Classrooms had individual cubbies for storage of children's belongings. Each classroom had child size tables and several chairs. For napping services, stackable cots and were stored in each classroom and labelled with the child’s name. Per director, children’s napping sheets are washed weekly. Children’s bathrooms were reviewed during inspection. Bathroom fixtures were in operating condition, with adequate supplies available for the children. Staff bathroom are on the lower level. Classrooms were the proper temperature, with ventilation, and lighting. Detergents, cleaning supplies, and all other toxins were made inaccessible. Outlets and trash bins were properly covered. Facility had functioning telephone service, (built-in) smoke/ carbon monoxide detector, and fully charged fire extinguisher; 2A:10BC. First aid kit was review during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS
FACILITY NUMBER: 414004114
VISIT DATE: 06/15/2022
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(Page 2)
At 10:00A.M., LPA inspected the outdoor play areas. Outdoor spaces were completely enclosed. Play structures was been anchored; and each space had its own shaded rest area. Soft rubber padding was installed around the play structure to absorb potential falls.

At 10:07AM., Based on observations, LPA confirmed several tricycles in play yards were missing the foot pedals. Facility was issued an Advisory Note: Technical Violation (LIC9102TV). Staff had removed damaged tricycles during inspection.

Per staff, refillable water jugs are brought outside. Jugs are refilled daily from non-contained sources.

At 10:20AM., LPA review the facility records including 10 children's files and 11 personnel files. Facility files reviewed had staff’s: Criminal Record Statements (LIC508); Declaration to Report Suspected Child Abuse (LIC9108); Required Transcripts; Proof of Required Immunization; and Notice of Employee Rights (LIC9052).

All personnel had their current mandated reporter training certification on file.

Children's files reviewed were complete and included their: Health History (LIC702); Identification of Emergency Information (LIC700); Consent for Medical Treatment (LIC627); Notification of Parent’s Rights (LIC995); and Immunization Records.

Staff present had the Cardiopulmonary Resuscitation/ First Aid certification on file, which expires on 8/27/2023. Facility is conducting emergency drills every six months. Last disaster drill done on 5/18/2022, and had been properly logged.

Per staff, program provides daily lunch and snack for children in care. LPA inspected facility kitchen. All food items inspected were current and properly labelled. LPA reminded director to ensure container brought from home must be labelled with child’s name.

Required posting are posted and included the: Childcare License, Notification of Parents Rights (PUB393), and Updated Emergency Disaster Plan (LIC610). (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS
FACILITY NUMBER: 414004114
VISIT DATE: 06/15/2022
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(Page 3)
Children's medication was reviewed during inspection. All medication was current.

Director was 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

Facility's Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on today's inspection, no deficiencies were observed in the areas evaluated, according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Director, Jenny Hobson and signature of this form acknowledges receipt of these documents.



The 'Notice of Site Visit' was provided to director and must remain posted for 30 days.

This report and rights to comment were discussed. This report must be available in the facility for public review. For additional questions, facility was advised to contact the Community Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC809 (FAS) - (06/04)
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