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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004875
Report Date: 12/06/2024
Date Signed: 12/06/2024 11:57:10 AM

Document Has Been Signed on 12/06/2024 11:57 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:COMMUNITY CARE PRESCHOOLFACILITY NUMBER:
414004875
ADMINISTRATOR/
DIRECTOR:		YU, KELIFACILITY TYPE:
850
ADDRESS:450 CHADBOURNE AVENUETELEPHONE:
(650) 690-0998
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY: 45TOTAL ENROLLED CHILDREN: 30CENSUS: 19DATE:
12/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:17 AM
MET WITH:Sobia IqbalTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On December 6, 2024, at approximately 8:30 AM, Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced annual inspection, met with the Site Supervisor, Sobia Iqbal, and explained the purpose of the visit. The facility operates Monday to Friday from 8:30 am to 5:30 pm.

Upon entry, LPA observed 5 staff members, including supervisor, and 19 preschool children were present. The facility operates within its capacity and complies with the staff/child ratio on this day.
LPA verified staff member's background clearance on Guardian website.

LPA inspected 2 daycare rooms divided by shelves, a dramatic play room, two bathrooms, and the outdoor play area with the site supervisor. LPA observed that the facility has 2 combined smoke and carbon monoxide detectors and a fully charged fire extinguisher model 2A:10BC located in the classroom. Site supervisor stated that the facility conducts a fire drill every 2 months and the latest one was conducted on 9/26/2024.

LPA observed the facility has age-appropriate furniture, toys, and educational materials in each classroom. The facility floor and rugs are in good condition and free of any hazards.
Sleeping cots observed in the storage area and per the director, individual blankets and sheets were brought from home and every week sent home to be washed.
LPA observed the children's bathroom- toilets and sinks were clean, sanitary, and in working condition and the water temperature was proper. LPA observed all cleaning solutions and other chemicals are properly stored and made inaccessible to the children.
See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 12/06/2024
NARRATIVE
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LPA observed outdoor play area with the site supervisor and found there is a variety of play and sports equipment available for the children. All play structures are in good repair and the playground is free from health and safety hazards.

LPA observed the facility has a fully stocked first aid kit and a functioning telephone. Per supervisor there is only one child has allergy in the center at this time. LPA observed the medication box properly stored and contained required forms alongside the EpiPen/medication in the original box and up to date.
The site supervisor stated they use the dramatic play room as a isolation area for ill children to wait for their guardian until they arrive.

According to the Sobia, the facility provides morning and afternoon snacks in addition to drinking water, and lunches are brought from home.

Per Supervisor, the facility is using electronic sign-in/out app called Bright Wheel and LPA observed all authorized representatives have signed for today.
All posting requirements are met by the facility and the License, Parent's Rights, California Child Passenger Safety Law observed by the LPA.

The LPA reviewed the facility records, 9 children's files, and 4 staff files. LPA found all required documents in the children's file including immunization records, LIC 700, and Personal-Parents Rights. LPA also observed all necessary documents were available in the staff file including valid CPR and Mandated Reporter Training.



The site supervisor 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.

See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: COMMUNITY CARE PRESCHOOL
FACILITY NUMBER: 414004875
VISIT DATE: 12/06/2024
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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.

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/.

Site supervisor 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.

A notice of site visit was given to site supervisor and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the site supervisor, Sobia Iqbal.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
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