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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004587
Report Date: 09/14/2021
Date Signed: 09/14/2021 03:41:09 PM

Document Has Been Signed on 09/14/2021 03:41 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:PINE CONE CHILDREN'S CENTERFACILITY NUMBER:
414004587
ADMINISTRATOR:ALVARADO, MICAELAFACILITY TYPE:
850
ADDRESS:900 BARRON AVENUETELEPHONE:
(650) 497-0013
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94063
CAPACITY: 102TOTAL ENROLLED CHILDREN: 0CENSUS: 41DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Mickey AlvaradoTIME COMPLETED:
03:45 PM
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Licensing Program Analyst(LPA) Tapia-Mandujano met with Director, Mickey Alvarado, for a random, annual inspection. Purpose of the inspection was explained. Present and caring for the children are 9 staff and 41 children. Facility is operating within its capacity and is in compliance with staff / child ratio on this day. Facility operates day care from Monday - Friday 7:30am-5:30pm.

LPA and director inspected the preschool classrooms and outside play yard for health and safety hazards. Facility has 5 classrooms (4 are currently operating). Storage for children's belongings are in each classroom, labeled with each child's names. LPA observed facility has a carbon monoxide detector, fire alarm system implemented, and fully equipped first aid kit. Fully charged fire extinguishers are stationed throughout the facility. Each classroom has a working telephone. All cleaning solutions, poisons and other chemicals are stored in the classroom with a child safety lock, inaccessible to children. Facility has age appropriate furniture. There were a variety of age appropriate toys and materials available for children in care. There is multiple bathrooms in each classroom, with two sinks in the bathroom area and inside the classroom. Bathrooms were observed to be in good working condition with appropriate sanitation products.

Facility serves snacks only. All food is stored and prepared properly to avoid contamination. Facility has a sufficient amount of sleeping mats available. Laundering and sanitization was discussed. Individual drinking bottles and other items provided by the parents are labeled, and readily available for children.

Facility uses electronic sign in and sign out. At time of inspection, all children were properly signed in to program. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log. Last emergency drill was logged August 24th, 2021. LPA reviewed the facility records. LPA reviewed children's files and staff's files.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: PINE CONE CHILDREN'S CENTER
FACILITY NUMBER: 414004587
VISIT DATE: 09/14/2021
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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.

Head teacher 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 head teacher to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Incidental Medical Services (IMS) policy was discussed. Program is not providing IMS at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: http://www.ada.gov/childqanda.htm

During today's inspection, LPA reviewed personnel files, there is an adult who is present in the facility that is not fingerprint cleared and/or associated to the facility.

**See following page for deficiencies cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1**

Type “A” violations were issued today. Licensee is advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to the 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 shall be maintained in all Children's files. Notice of site Visit will be posted and should remain posted for 30 days, failure to post will result in an immediate civil penalty.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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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: PINE CONE CHILDREN'S CENTER
FACILITY NUMBER: 414004587
VISIT DATE: 09/14/2021
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After the inspection, an exit interview was conducted with Director, Mickey Alvarado. Report was reviewed and signed by Director. Today’s report dated September 13th, 2021 and notice of site visit will be emailed mickey.alvarado@brighthorizons.com to by close of business. Head teacher was advised to acknowledge receipt of report. Head teacher was reminded that a site notice shall be posted in a prominent place in facility for 30 days during the hours of operation. Failure to maintain postings as required will result in a civil penalty of $100.

This report is public and can be reviewed. This report must be available in the facility for public review. Head teacher was advised to contact San Bruno Regional Office for any additional questions, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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Document Has Been Signed on 09/14/2021 03:41 PM - It Cannot Be Edited


Created By: Leslit Tapia-Mandujano On 09/14/2021 at 02:36 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PINE CONE CHILDREN'S CENTER
FACILITY NUMBER: 414004587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/14/2021
Section Cited
CCR
101170(e)(1)

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101170(e):All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department. This evidencie is not met by evidence by:
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At 11:30am, LPA was reviewing files and noticed an individual adult was not in the association list. Individual left facility while LPA was still in the facility.
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Based on LPA's observation and file review, there was an uncleared and/or unassociated adult present in the facility while daycare children were present. This is an immediate health and safety hazard for the children in care.
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Individual redid fingerprint clearance today. Director understands that individual may not return until she is cleared and associated to the facility.
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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:Cindy Interiano
LICENSING EVALUATOR NAME:Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


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