414004883-4-14-2023-05-CC-MROZ-CQW3SC-20230414183009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004883
Report Date: 04/14/2023
Date Signed: 04/14/2023 06:30:21 PM

Document Has Been Signed on 04/14/2023 06:30 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	EMPIRE PRESCHOOL SM		FACILITY NUMBER:	414004883
ADMINISTRATOR:	SARAH JEN		FACILITY TYPE:	850
ADDRESS:	3080 LA SELVA STREET		TELEPHONE:	(650) 678-3638
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY: 102	TOTAL ENROLLED CHILDREN: 25	CENSUS: 23	DATE:	04/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Sarah Jen and Bonnie Li		TIME COMPLETED:	06:45 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	Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced annual inspection. Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced annual inspection. LPA met with Director Sarah Jen and explained purpose of inspection. Center has a preschool program and an infant program under license #414004884. Present in the preschool center were the Director, three teacher's aides and 23 preschool aged children. Director was working under the infant license as a teacher. Facility representative Bonnie Li arrived awhile later. Center is operating within capacity requirements but is not in compliance with child to staff ratio. Hours of operation are Monday to Friday from 8:00am to 6:00pm. LPA inspected classroom 1, 2, and 3 and outdoor play area with Director. There are no bodies of water, firearms, or weapons on the premises. The center is in good repair with proper temperature and ventilation and is free of any hazards. All furniture is in good condition. Classrooms have age appropriate toys and equipment. Classroom 2 is currently used as a napping room for children in classroom 1. Napping equipment includes cots which are in good condition. Cots are properly stored when not in use. A first aid kit is available in each classroom. All cleaning products and toxins are inaccessible to children. Outdoor play area is fenced for supervision. The outdoor toys and equipment in the play area are age appropriate and in good condition. All required postings are properly posted in the bulletin board in front of the center. Center provides a hot lunch and morning and afternoon snacks. Lunch is cooked in-house by staff. Food prep area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. Classroom 3 shares a bathroom with the infant classroom. Bathroom area has five toilets and five sinks for children use. A seond bathroom is shared between classrooms 1 and 2. Bathroom areas appear to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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 04/14/2023 06:30 PM - It Cannot Be Edited

Created By: Marie Rodriguez On 04/14/2023 at 04:22 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: EMPIRE PRESCHOOL SM	FACILITY NUMBER: 414004883
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101216.3(a)

Teacher-Child Ratio

(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above due to Staff S1, S2, and S3 not having the required early childhood education (ECE) units to be a teacher and is considered a teacher's aide which poses an immediate health and safety risk to children in care. To be qualified as a teacher, an employee must have completed at least 6 semester units of ECE and enrolled in at least 2 semester units at a college to be fully qualified.
	POC Due Date: 04/17/2023
	Plan of Correction
1 2 3 4	Facility representative will ensure that qualified teachers will be in the appropriate classrooms and teacher's aides will be redistributed to ensure facility is following teacher requirements and correct staff ratio. Facility representative is also working with teacher's aides to get them registered for ECE classes. Facility representative will provide LPA with a layout of the classrooms and assigned teachers and teacher's aides for each classroom.

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:

Daniel J Oquendo

LICENSING EVALUATOR NAME:

Marie Rodriguez

LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 04/14/2023 06:30 PM - It Cannot Be Edited

Created By: Marie Rodriguez On 04/14/2023 at 04:22 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: EMPIRE PRESCHOOL SM	FACILITY NUMBER: 414004883
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Last emergency drill was conducted on March 18, 2022 which poses a potential health and safety risk to children in care.
	POC Due Date: 04/21/2023
	Plan of Correction
1 2 3 4	Facility will conduct an emergency drill and provide LPA with the log showing it has been completed by the 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:

Daniel J Oquendo

LICENSING EVALUATOR NAME:

Marie Rodriguez

LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: EMPIRE PRESCHOOL SM	FACILITY NUMBER: 414004883
	VISIT DATE: 04/14/2023

NARRATIVE

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Last emergency drill was conducted on March 18, 2022. Sign-in/out sheets are done electronically. The center has a complete electronic record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system and sprinkler system throughout the center. There is a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available on-site.

Ten children records were reviewed and complete. All children have a record of emergency identification information on file.

Deficiencies cited today under California Code of Regulations, Title 22, Division 12, which follows on LIC 809-D.

LPA Marie Rodriguez informed facility representative Bonnie Li that this report dated April 14, 2023 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health and safety of children in care.

LPA Marie Rodriguez also informed the facility representative to provide a copy of this licensing report dated April 14, 2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An annual continuation will be completed at a later date.

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 was conducted and report was reviewed with Facility Representative Bonnie Li. Appeals Rights was given to facility representative.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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