414004875-9-21-2023-05-CC-CQUO-CVVSGQ-20230921135218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004875
Report Date: 09/21/2023
Date Signed: 09/21/2023 01:52:25 PM

Document Has Been Signed on 09/21/2023 01:52 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
SAN BRUNO CC RO, 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: 23	CENSUS: 20	DATE:	09/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Keli Yu		TIME COMPLETED:	02:00 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 September 21, 2023 at approximately 10:45am, Licensing Program Analysts (LPAs) Catrina Quimbo and Jonathan Tse, conducted an unannounced, annual inspection. LPAs met with director, Keli Yu, and explained the purpose of the inspection. LPAs' visit also included a case management inspection. LPAs observed that required documents were posted. Present during visit included 20 preschool children and 6 teaching staff (including director). Facility is operating within capacity limits and ratio during LPAs' visit. Program is licensed to operate on the lower level of the New Vision United Methodist Church. In February 2023, due to flooding, preschool program was temporarily approved to operate in the upper level of the facility (Educational Building) in classrooms #103 and #104 only. Preschool program's already licensed classrooms' flooring and lower wall fixtures were to be reconstructed after storm. During today's visit, LPAs inspected already licensed classrooms, with new flooring and lower wall fixtures, for health and safety hazards. Classrooms and designated play areas are observed to be kept in clean and orderly condition. Toys, furnishings, and learning materials are age-appropriate. Garbage bins were observed to be covered with tight-fitting lids. The facility has a fully equipped first aid kit. The playground area is kept in a clean and orderly condition. The bathroom toilets and sinks were observed to be in working condition. LPAs observed electrical outlets to be covered and made inaccessible. Facility conducted and properly documented an emergency disaster drill on 8/16/2023. Continued on Page Two

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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

FACILITY NAME: COMMUNITY CARE PRESCHOOL	FACILITY NUMBER: 414004875
	VISIT DATE: 09/21/2023

NARRATIVE

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The facility has multiple smoke detectors and carbon monoxide detectors installed. LPAs observed the carbon monoxide detector to be operational. There are fully charged fire extinguishers present in the facility of appropriate size. All poisons, cleaning products and other potentially harmful substances have been stored in a locked cabinet that is inaccessible to children.

Facility utilizes the Brightwheel application for children's sign-in and sign-out. Facility prepares morning and afternoon snacks for the children. The refrigerator was observed to be kept clean and organized. LPAs did not observe any poisonous materials to be stored in food preparation area. Children bring lunch and water bottles from home. Facility purchases drinking water for children to refill their water containers, if needed. Facility provides cots for children to nap in, and cleans them weekly. Children bring their own bedding from home on Mondays and bring them back home to be cleaned on Friday.

LPAs reviewed five staff files and five children's files. The children's files were found to be complete with emergency information and immunization requirements. LPAs reminded director about Mandated Reporter Training requirements for all staff who work with children. Of the five staff files reviewed, four staff members have current First Aid and CPR certifications. Director is aware that a staff member without First Aid and CPR certification is not allowed to supervise children by themselves.

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.

Facility representative 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.
Continued on Page Three

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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: COMMUNITY CARE PRESCHOOL	FACILITY NUMBER: 414004875
	VISIT DATE: 09/21/2023

NARRATIVE

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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.

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

Director has scheduled for a water sampler to test water fixtures used for food preparation for lead on 9/22/2023.

LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative 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/.

Facility representative 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.

Facility was issued a Type B deficiency for not completing lead testing requirements by January 1, 2023. A plan of correction was discussed with director. Appeal Rights were provided during visit.

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

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

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/21/2023 01:52 PM - It Cannot Be Edited

Created By: Catrina Quimbo On 09/21/2023 at 01:04 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: COMMUNITY CARE PRESCHOOL	FACILITY NUMBER: 414004875
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2023

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 observation, interview, record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/04/2023
	Plan of Correction
1 2 3 4	Director has scheduled to test water fixtures used for food preparation for lead levels on 09/22/2023. Completed LIC9275, LIC9276, LIC999 and results of lead levels to be submitted to LPA no later than POC due date.

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:

Catrina Quimbo

LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC809 (FAS) - (06/04)

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