414004115-12-20-2023-05-CC-LGOZ-CYPTET-20231220134024

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004115
Report Date: 12/20/2023
Date Signed: 12/20/2023 01:40:32 PM

Document Has Been Signed on 12/20/2023 01:40 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:	PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF		FACILITY NUMBER:	414004115
ADMINISTRATOR:	JENNY HOBSON		FACILITY TYPE:	830
ADDRESS:	1311 SO. EL CAMINO REAL		TELEPHONE:	(650) 340-7241
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 18	DATE:	12/20/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Alexander Banores		TIME COMPLETED:	01:45 PM

NARRATIVE

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On 12/20/2023 at 9:10AM., Licensing Program Analysts, (LPAs) Luis J. Gomez and Melissa Zaragoza met with Coordinator, Alexander Banores. Purpose of inspection was explained and was for an Unannounced, Annual/ Random inspection. Director, Jenny Hobson arrived during inspection. This is a combination infant center with a preschool program on-site. Present was the director and 6 staff supervising 18 children. Children had been properly signed in. The infant program utilizes two rooms: Caterpillars (1-1.5 years old), Cocoons (0-1 years old), and one, shared, outdoor play yard. Waiver for rational use outdoor space was observed posted in the lobby. The days and hours of operation are Monday- Friday, 8:00AM- 6:00PM. Per director, program operates year-round. LPAs inspected facility, indoors and outdoors, for health and safety hazards.

At 9:50AM., LPAs observed the following: Infant classrooms were clean, orderly, with age-appropriate playthings available. Floors/ ground surfaces were free of obstructions or hazards. Accessible furniture, playthings, and materials inspected were in like-new condition. LPAs observed storage cubbies available for children’s belongings. The diaper changing tables are located within arm’s reach of a sink. Food preparation area/ sinks are located separately, with nearby food refrigeration and shelving.

Feeding chairs had stable bases, with detachable table components. Infant bottles and feeding supplies had been correctly stored, labeled with children’s names and date received. Per director, bottles are taken home by the families daily to be washed. For napping services, LPA observed several infant cribs and stackable cots. Infant cribs were equipped with tight-fitting sheets and properly sized mattresses. Cribs available have adequate visibility to ensure supervision of napping infants. Per director, napping sheets are washed on-site daily. Infant classrooms were a comfortable temperature, with ventilation and lighting. Trash bins and outlets had been properly covered. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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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Document is an Amendment of Original Document on 01/02/2024 12:02 PM

Created By: Luis Gomez On 12/20/2023 at 12:42 PM

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF	FACILITY NUMBER: 414004115
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 12:10PM., Based on observations, Record Review, and Interviews, LPAs confirmed present staff member (S1) does not have criminal record clearance or facility association on file. This poses an immediate health and safety risk to children in care.
	POC Due Date: 12/21/2023
	Plan of Correction
1 2 3 4	Director will ensure staff, S1, received proper criminal record clearance and association prior to presence in the licensed chldcare facility. Proof of correction will be submitted to the 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: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF	FACILITY NUMBER: 414004115
	VISIT DATE: 12/20/2023

NARRATIVE

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(Page 2)
Detergents, cleaning supplies, or sharp or hazardous objects have been made inaccessible to children. Facility has a smoke detector (Built-in), testable carbon monoxide detector, and several fire extinguishers (2A:10BC).

At 10:20AM., LPA inspected the outdoor play area. Area is completely enclosed, with turf padding installed for added safety. Play area was observed free of debris or hazardous plants. Outdoor supplies were in good repair. Per director, for water services refillable bottles are available for children inside and outside.

Food Preparation/ Storage room was reviewed during inspection. All food items inspected were current, and had been properly stored. The storage room was observed clean, free of any trash or rubbish.

At 10:40AM., LPA reviewed facility records including 5 children’s files and 6 personnel files. Staff files reviewed and contained the: Notice of Employee Rights (LIC9052); Teacher Qualifications; Personnel Record (LIC701); ‘Mandated Reporter Training’ Certifications (AB1207); and Proof of required immunization.

At 12:10PM., Based on observations, Record Review, and Interviews, LPAs confirmed present staff member (S1) does not have criminal record clearance or facility association on file.

Children’s files were reviewed and included the: Infant Needs and Services Plans, Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700), Individual Sleeping Plans (LIC9227) for qualifying infants in care; Updated Immunization Records; and the signed Admissions Agreement. Per director, staff review and document the infant napping conditions every 15 minutes. Completed napping logs were reviewed during inspection.

Staff’s CPR/ 1^st Aide Certification was current, expiring: 8/27/2023.
Disaster drills are being conducted, with the last drill completed (11/10/2023) properly logged. Required posting were observed in lobby, including the: Facility License; Emergency Disaster Plan (LIC610); Seat Beat Safety Laws; Notification of Parent’s Rights (LIC995A). (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: PAPILLON PRESCHOOL MANAGED BY BRIGHT HORIZONS INF	FACILITY NUMBER: 414004115
	VISIT DATE: 12/20/2023

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(Page 3)
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

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.
LPAs referred Director to the Department website regarding Lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

LPAs discussed safe sleep regulations with the director and discussed Child Care Licensing Safe Sleep webpage at: http://www.cdss.ca.gov/inforesource/child-care-licensing/public-information-and-resouce/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: http://www.cpsc.gov/ and recommend they register all infant devices with the CPSC to be notified of any recalls on their purchased requirement.

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, appeal rights, and report was discussed with Director, Jenny Hobson. Director's signature on this form acknowledges receipt of these documents.

Type “A” violation was issued today. Director was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

Civil penalty of $100.00 was assessed during inspection.

This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility 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
LPA unable to print report during inspection. Copy of report and all pertaining documents will be send to director at a later date.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC809 (FAS) - (06/04)

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