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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004915
Report Date: 08/11/2022
Date Signed: 08/11/2022 11:49:37 AM

Document Has Been Signed on 08/11/2022 11:49 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:REDWOOD CHURCH AFTER-SCHOOL CHILD CAREFACILITY NUMBER:
414004915
ADMINISTRATOR:CHANG, PAMELAFACILITY TYPE:
840
ADDRESS:901 MADISON AVENUETELEPHONE:
(650) 366-1223
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 25TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/11/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Matt Campbell, Pamela Chang, Jennifer CorralesTIME COMPLETED:
12:00 PM
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On August 11, 2022 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an announced pre-licensing inspection. LPA met with senior minister, Matt Campbell, director Pamela Chang, and preschool director, Jennifer Corrales. The purpose of the visit was explained. Applicant is requesting a school age license for 25 children (TK to 8th grade). The facility plans to operate Monday through Friday from 1:00pm to 5:30pm during the academic school year.

The after school program will operate on Redwood Church property. The designated after school director will be Pamela Chang. The facility was inspected, indoors and outdoors, for health and safety hazards. The school age program is exempt from requirements for indoor and outdoor space square footage, fencing, and toilet/sink ratios. No measurements were taken during the inspection.

Indoors: The program will operate out of portable classrooms A and B only.

Both classrooms are currently licensed and used for preschool program. Applicants will submit a schedule of the classrooms' use to avoid preschool children and after school children using the classrooms at the same time and/or co-mingling. Senior minister, school age director and preschool director are aware children from preschool program are not to co-mingle with school age program children.

Classrooms are equipped with appropriate furniture that is in good working condition. Storage for children's belongings are located outside the classrooms with sufficient cubby and hook space. LPA observed classrooms to be equipped with carbon monoxide detectors, fire extinguishers and fire alarm system. Emergency backpacks with fully stocked first aid kits and emergency supplies are available in the classrooms that are brought out to the outdoor area.
(Continue Report on Page 2...)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: REDWOOD CHURCH AFTER-SCHOOL CHILD CARE
FACILITY NUMBER: 414004915
VISIT DATE: 08/11/2022
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Classrooms are equipped with age appropriate toys, materials and furniture. All toxins and hazardous items will be stored in classrooms' high shelves, inaccessible to children. Designated isolation area for the children will be the Church's office.

Restrooms are located away from the classrooms, near Fellowship hall. Restrooms allow for individual privacy. LPA observed restroom to be clean and in proper working condition. Applicants are aware restrooms cannot be used by enrolled children and staff simultaneously. Applicants are also aware children walking to and from the restrooms must always be supervised and monitored.

Program will provide dry, afternoon snacks only. Applicants are aware food is not to be stored near toxins and poisons. Water is accessible to enrolled children with multiple accessible water fountains.

Outdoors: After school program's outdoor area is separate from preschool program area. Outdoor area is located next to Fellowship hall (walk through only). After school program has exclusive use of outdoor area. LPA observed outdoor area to be clean and safe. Entire outdoor area is enclosed by a fence that is at least four feet tall. Per applicants, toys and materials will be carried to the outdoor area. LPA did not observe any loose debris, pools, spas or bodies of water in the outdoor area. Applicants are aware children walking to and from the outdoor area must always be supervised and monitored.

LPA reminded director disaster drills must be conducted at least once every six months and properly logged and maintained. All required licensing documents and posters will be posted outside the portable classrooms, available for review.

Applicants were 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
(Continued Report on Page 3...)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: REDWOOD CHURCH AFTER-SCHOOL CHILD CARE
FACILITY NUMBER: 414004915
VISIT DATE: 08/11/2022
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LPA reviewed with director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Prior to recommended licensure, following must be completed:
-Fire clearance.
-Submission of preschool and after school classrooms usage schedule.
-LPA's review of resubmitted documents.

Exit interview conducted and report was reviewed with senior minister, Matt Campbell, school age director, Pamela Chang, and preschool director, Jennifer Corrales.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3