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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004883
Report Date: 08/16/2023
Date Signed: 08/16/2023 10:38:09 AM

Document Has Been Signed on 08/16/2023 10:38 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:EMPIRE PRESCHOOL SMFACILITY NUMBER:
414004883
ADMINISTRATOR:SARAH JENFACILITY TYPE:
850
ADDRESS:3080 LA SELVA STREETTELEPHONE:
(650) 678-3638
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 102TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
08/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Linda TongTIME COMPLETED:
11:00 AM
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On August 16, 2023 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, case management visit. LPA met with licensee, Linda Tong, and explained the purpose of the visit. Facility is a combination preschool and infant program.

At the start of LPA's visit, children were being dropped off to the center. Present at the start of LPA's visit included 3 preschool children with 1 teaching staff (T1).

LPA inspected preschool classroom and reviewed staff and children's files during visit. Preschool program is currently operating in Preschool classroom #1 only. LPA observed classroom to be clean and in good repair. Classroom had appropriate temperature and ventilation. Classroom was equipped with age appropriate toys, materials and furniture.

At approximately 9:30am, LPA observed 8 preschool children with T1. Preschool program is operating within capacity limits and ratio. Per licensee, an aide is available to T1 when needed. LPA reviewed T1's file and observed file to be complete. LPA observed T1 to be a fully qualified teacher, have a current Mandated Reporter certification and have their required immunizations available for review. During visit, LPA observed children to always be supervised by teaching staff.

LPA reviewed 2 random preschool children's files, which were also observed to be complete. Children's files were observed to have completed and signed Acknowledgement of Receipt of Licensing Reports (LIC9224) that were made available for review. LPA observed Notice of Site visits that documented facility's deficiencies to be properly posted in main entrance of facility, also available for review.

During visit, LPA and licensee discussed staff's working hours and schedules to maintain teacher/child ratio and supervision. Licensee is aware children must always be supervised and unqualified staff are to not be left alone with children.

After today's visit, no deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Linda Tong.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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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