414004875-1-26-2023-05-CC-CQUO-CNFSG8-20230126125129

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004875
Report Date: 01/26/2023
Date Signed: 01/26/2023 12:52:18 PM

Document Has Been Signed on 01/26/2023 12:52 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
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	COMMUNITY CARE PRESCHOOL		FACILITY NUMBER:	414004875
ADMINISTRATOR:	YU, KELI		FACILITY TYPE:	850
ADDRESS:	450 CHADBOURNE AVENUE		TELEPHONE:	(650) 690-0998
CITY:	MILLBRAE	STATE: CA	ZIP CODE:	94030
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 22	CENSUS: 19	DATE:	01/26/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Keli Yu		TIME COMPLETED:	01:00 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 January 26, 2023 at approximately 10:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a case management visit at The Community Care Preschool. LPA met with director, Keli Yu, and explained the purpose of the visit. Present during visit included 5 staff members (including director) and 19 preschool children. Facility is operating within capacity limits and ratio during LPA's visit. Entire facility is the New Vision United Methodist Church with one address. Program currently operates on the lower level of the building with a separate entrance for preschool program. Main entrance to program is located on Poplar Avenue street side, through playground area. Due to recent storm, facility's currently licensed space experienced flooding that has since been cleaned and dried. Currently licensed classrooms will be repaired and reconstructed. Director requested to temporarily operate preschool program in facility's "Educational Building" in Classrooms #103 and #104 only, while reconstruction occurs in currently licensed space. Hours of operation will continue to be from Monday to Friday 8:00am to 5:00pm. New Vision United Methodist Church last received a fire inspection 10/05/2022. The facility was inspected, indoors and outdoors, for health and safety hazards. Classrooms #103 and #104 were measured to verify space is sufficient for the 22 currently enrolled children. Program plans to use furniture, toys and materials in currently licensed space to temporary space that will be used. (Continue Report on Page 2...)

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COMMUNITY CARE PRESCHOOL	FACILITY NUMBER: 414004875
	VISIT DATE: 01/26/2023

NARRATIVE

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Indoors: The program will have access to Classroom #103, Classroom #104 and gym. Classroom #103 has a total square footage of 559.57 sq ft allowing for a capacity of 15 children. Classroom #104 has a total square footage of 776.80 sq ft allowing for a capacity of 22 children. Program also has access to gym that will be used as a multi-purpose area. Due to gym being a multi-purpose area and not designed as a classroom, space was not measured for or counted towards overall capacity. Total square footage equals 1,336.37 sq ft. allowing for a capacity of 38 children.

Program does not plan to increase or decrease overall licensed capacity of 45 children. Classrooms #103 and #104 will only be used temporarily while construction is completed. Director is aware temporary classroom spaces do not equal already licensed capacity of 45 children. Director is aware temporary classroom spaces cannot operate with more than 38 children.

Both classrooms are equipped with a sink that children will have access to. There is one shared bathroom in between classrooms that includes 1 additional sink and 1 toilet. Program has access to Church's "Women" restroom that includes 2 separate bathroom stalls with 2 separate toilets and 1 sink. 1 of the 2 stalls located in Women's restroom will be designated for preschool program use only.

Director will make preschool bathroom stall have clear signage that states no adult can use preschool bathroom stall and preschool bathroom stall is for preschool children only. Director is aware no staff member or adult can use second stall while preschool children use designated preschool bathroom stall. Director is aware preschool children must always be accompanied and supervised going to and from Women's bathroom.

Main entrance to temporary space will be located on Chadbourne Avenue street side. Children will go to and from outdoor, playground area through gym. Director is aware children are to be accompanied and supervised going to and from outdoor area.

Program provides a snack service only. Children's families provide children's meals. Program plans to store food in classroom's high shelves and/or facility kitchen. Children will not have access to facility's kitchen. Storage for children's belongings will be kept in hallway, outside of classrooms.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: COMMUNITY CARE PRESCHOOL	FACILITY NUMBER: 414004875
	VISIT DATE: 01/26/2023

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Once construction is complete, program will utilize already licensed space located on lower level of building. Classrooms #103 and #104 will no longer be used.

Director understands LPA must conduct a follow up visit and must approve of reconstructed space prior to program using space. Director is aware new fire inspection may be needed for reconstructed space as well.

During LPA's visit, director provided LPA copy of fire inspection report conducted on October 5, 2022.

Prior to approval of Classrooms #103 and #104, following must be completed:
-Installation of carbon monoxide detectors in both classrooms.
-Management approval.

No deficiencies were observed today. LPA reminded director to notify department when construction has been completed.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the director, Keli Yu,

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC809 (FAS) - (06/04)

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