414004686-8-16-2023-05-CC-LGOZ-CURRJD-20230816130342

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004686
Report Date: 08/16/2023
Date Signed: 08/16/2023 01:03:55 PM

Document Has Been Signed on 08/16/2023 01:03 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:	IHSD LAKEWOOD CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	414004686
ADMINISTRATOR:	GHEITH, KIFAH		FACILITY TYPE:	850
ADDRESS:	69 TOWER ROAD		TELEPHONE:	(650) 504-9928
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 3	DATE:	08/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kifah Gheith		TIME COMPLETED:	01:05 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 8/16/2023 at 9:00AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Kifah Gheith. Purpose of inspection was explained and was for an Unannounced, Annual Random inspection. Facility is licensed to operate preschool-age classroom at the San Mateo County Office of Education Building. Present was the director and 2 staff supervising 3 children. Children present had been properly signed in. Staff presents have criminal record clearances on file. Program utilizes one classroom: Room #2, and one Outdoor Play Area. Per Director, Program operates year-around. LPA inspected facility, indoors and outdoors, with director for health and safety hazards. At 9:20AM., LPA observed the following: Classroom was clean, orderly, with age-appropriate playthings available for the children. Floor/ground surfaces were free of any obstructions or possible hazards. Labeled cubbies are available for storage of children's belongings. LPA observed accessible furniture, books, and supplies were free of sharp corners or splinters. Classroom is equipped with child- sized tables and chairs for snack and seated activities. Children’s bathrooms are maintained clean with fixtures (2 toilets, 4 sinks) in operating condition. Diaper changing table is available to staff. Per director, area is disinfected after each use. Staff bathroom is located separate. For napping services, stackable cots are stored in classroom. Napping cots inspected were made of cleanable material. Per Director, napping sheets are washed daily. Facility has acceptable ventilation and lighting. Disinfectants, toxins, and cleaning compounds have been stored inaccessible to children. Electrical outlets and trash bins have been covered. Room #2 has testable smoke/ carbon monoxide combination detector, telephone, and several fully charged fire extinguishers: 2A:10BC. First aid kit reviewed is fully stocked. At 9:45AM, LPA inspected the outdoor play area. Area was completely enclosed with fencing. Absorbent material had been installed around structure. Per director, sand box is reviewed daily by staff, for any hazards or foreign objects. Climbing structures is properly anchored. Large, shaded resting area with water services is available for children. LPA reminded director to ensure outside playthings and equipment are maintained clean and in proper repair. During inspection, director removed all broken toys and equipment from play area. Advisory Note Technical Violation (LIC9102TV) was issued. During inspection, LPA reviewed food preparation/storage area. Food items inspected had been properly stored. Food preparation area was observed clean, free of trash or rubbish. (REFER TO 809C, FOR CONT.)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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 Has Been Signed on 08/16/2023 01:03 PM - It Cannot Be Edited

Created By: Luis Gomez On 08/16/2023 at 11:54 AM

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: IHSD LAKEWOOD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004686
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

(a) (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	At 11:15AM., Based on interview, observations, and record review, LPA confirmed facility's fixtures (Room #2) used for drinking water, have not been tested for lead contamination levels. This poses a potential health and safety risk to children in care.
	POC Due Date: 08/23/2023
	Plan of Correction
1 2 3 4	Director will ensure fixtures used for drinking water are tested and results are submitted to the department by the due date: 8/23/2023. 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: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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: IHSD LAKEWOOD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004686
	VISIT DATE: 08/16/2023

NARRATIVE

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(Page 2)
At 10:15AM LPA reviewed facility records including 3 children’s files and 2 personnel files. Staff’s files contained the: Notice of Employee Rights (LIC9052); Education Verification; Personnel Record (LIC501); and Required Proof of Immunization.

At 10:30AM., Based on record review, LPA confirmed staff, S1’s, required “Mandated Reporter Training’ certifications (AB1207) had expired. Advisory Note: Technical Assistance (LIC9102TA) was issued.

Staff's ‘Cardiopulmonary Resuscitation and First Aid’ certifications on file were current, expiring: 8/2024.

Children’s files contained the: Consent for Emergency Medical Treatment (LIC627); Immunization Records, Identification and Emergency Information (LIC700); Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

LPA reminded director to ensure ‘Written Medical Assessments’ are stored in the children’s files. Advisory note: Technical Assistance (LIC9102TA) was issued.

At 11:15AM., Based on interview, observations, and record review, LPA confirmed facility's fixtures (Room #2) used for drinking water, have not been tested for lead contamination levels.

Emergency disaster drill are conducted monthly. Last drill completed on 7/26/2023, is properly logged.

LPA observed required posting in facility, including the: Facility License; Emergency Disaster Plan (LIC610); Earthquake Preparedness Checklist; Notification of Parent’s Rights (PUB394); Updated Snack Menu (August); and Child Passenger Safety Laws (PUB369).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes 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) 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-care-centers/.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: IHSD LAKEWOOD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414004686
	VISIT DATE: 08/16/2023

NARRATIVE

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(Page 3)
Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

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

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, appeal rights and report was discussed with Director, Kifah Gheith signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director 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

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC809 (FAS) - (06/04)

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