414004777-4-5-2024-05-CC-MZAA-D42PX3-20240405114140

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004777
Report Date: 04/05/2024
Date Signed: 04/05/2024 11:41:47 AM

Document Has Been Signed on 04/05/2024 11:41 AM - 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:	CREATIVE LEARNING PRESCHOOL		FACILITY NUMBER:	414004777
ADMINISTRATOR/ DIRECTOR:	YA CHIEN KO		FACILITY TYPE:	850
ADDRESS:	3399 CSM DRIVE		TELEPHONE:	(415) 860-3386
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94402
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 23	CENSUS: 0	DATE:	04/05/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Director, Judy Ko		TIME VISIT/ INSPECTION COMPLETED:	12:00 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 April 5, 2024 at approximately 8:30 am, Licensing Program Analyst’s (LPA) Melissa Zaragoza and Catrina Quimbo, conducted an unannounced, annual inspection. LPA's met with Director, Ya Chien Ko (Judy Ko), and explained the purpose of the visit. Director let us know there are no children currently enrolled in preschool program. Preschool shares the space with the Church, and Heritage Program. In the building, Preschool operates in two classrooms, classrooms #105 and #106 are preschool rooms. Classroom #106 will also be used for napping. Hours of operation are Monday through Friday 8:00am to 6:00pm. Present during LPA's visit was the director, 0 preschool age children, and 0 teaching staff. LPA's inspected facility, indoors and outdoors, for health and safety hazards. Classroom includes a variety of toys and materials that were in good condition. LPAs observed classroom to have age-appropriate furniture, equipment and materials. LPAs observed electrical outlets in classrooms to be made inaccessible with child safety covers and/or blocked by furniture. There is a separate room utilized for napping children. Napping area was observed to be appropriately equipped. Cots that will be used are stored in the storage shed. Children will use their individual cots, and sleep in the nursery room (classroom #106). LPAs observed electrical outlets in napping room to also be made inaccessible with child safety locks. Facility is equipped with a fully charged fire extinguisher, fully stocked first aid kit, smoke alarm system and carbon monoxide detector. LPAs tested carbon monoxide detector in both classrooms, which were observed to be working. Storage for children's belongings are located inside the classroom, that will be labeled with children's individual names. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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

FACILITY NAME: CREATIVE LEARNING PRESCHOOL	FACILITY NUMBER: 414004777
	VISIT DATE: 04/05/2024

NARRATIVE

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Bathroom for children's use was observed to be clean. There is a bathroom in both classrooms. Sinks and toilets were in working condition. Sinks accessible to children and were equipped with appropriate sanitation products. LPAs observed no cleaning solutions, poisons, and other hazardous materials to be stored in bathroom. LPAs did not observe any accessible poisons or chemicals in classroom.

Program plans to provide dry snacks only. Snack is stored in refrigerator, in classroom #106. LPAs observed refrigerator to be clean with food appropriately stored and maintained. Garbage cans in classroom were observed to have tight fitting lids. Children will use the water fountain in the hallway for drinking.

Outdoor area is entirely enclosed and fenced. LPAs did not observe loose debris or materials in outdoor area. There is a play structure that has tanbark flooring. Outdoor play structure is shared, preschool will play outside when other programs are not using it. Outdoor materials are stored in classroom closet, that was observed to be in good working condition. LPAs did not observe any pools, spas or bodies of water on site.

Program will utilize a desk where parents will provide signatures for children's sign in and out records. LPAs observed licensing posters and documents to be properly posted but, in accessible to parents. Director will move the location for the forms required to be posted to the front entrance, where parents can see them. Program plans to conduct disaster drills and properly log.

LPAs reviewed no facility records since there are no staff hired and no children enrolled. Director's packet is complete and was previously submitted to LPA. Director was reminded to have their director packet on site. Director understands which are the required forms for children’s records and staff records.

Director was reminded all staff hired are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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: CREATIVE LEARNING PRESCHOOL	FACILITY NUMBER: 414004777
	VISIT DATE: 04/05/2024

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Licensee was reminded that all adults 18 and over, 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

Water quality was tested on 3/14/23 and results complied. There was one deficiency sited during today’s inspection. Lead water was tested after the due date of 1/1/23. LPAs informed director, Judy Ko that this report dated 04/05/2024 document(s) (1) Type B citation.

LPA's discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Program was cited a Type B citation for not completing lead water testing requirement by due date of January 2023. Appeal Rights were provided. Facility's lead levels were within the 5.5ppb threshold, therefore deficiency cited today will also be cleared today.

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

Exit interview conducted and report was reviewed with the director, Ya Chien Ko (Judy Ko).

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/05/2024 11:41 AM - It Cannot Be Edited

Created By: Melissa Zaragoza On 04/05/2024 at 11:24 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: CREATIVE LEARNING PRESCHOOL	FACILITY NUMBER: 414004777
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(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	Based on interview and record review, the licensee did not comply with the section cited above by not completing lead testing by January 1, 2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/05/2024
	Plan of Correction
1 2 3 4	Facility tested water fixtures May 2023. Water fixture tested is below the 5.5 ppb threshold. Director submitted completed LIC9275, LIC9276, LIC999 and results of lead levels to department. Director to verify with certified lead water sampler results will be uploaded to licensing lead testing database.

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:

Melissa Zaragoza

LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

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