414004915-10-11-2023-05-CC-MOLN-CWHUPH-20231011154535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004915
Report Date: 10/11/2023
Date Signed: 10/11/2023 03:45:46 PM

Document Has Been Signed on 10/11/2023 03:45 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:	REDWOOD CHURCH AFTER-SCHOOL CHILD CARE		FACILITY NUMBER:	414004915
ADMINISTRATOR:	CHANG, PAMELA		FACILITY TYPE:	840
ADDRESS:	901 MADISON AVENUE		TELEPHONE:	(650) 366-1223
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 7	CENSUS: 6	DATE:	10/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Kareena Campbell		TIME COMPLETED:	04:00 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 October 11, 2023, at 1:20 PM Licensing Program Analysts (LPAs) Maria Olguin-Leon and Jonathan Tse met with Director, Kareena Campbell for an unannounced annual inspection. Purpose of inspection was explained. Present today was Director, 2 staff and 6 school age children. Facility is operating within capacity and in compliance with staff child ratio. Facility operates after-school program from Monday to Friday 2:30PM to 5:30PM and open during school closure from 8:00AM to 5:30PM. LPAs and Director toured the facility for health and safety hazards. Facility operates on the campus of Redwood Church in a portable in classroom A & B. Portable is clean with proper ventilation. There are plenty of age-appropriate toys/games, books, tables, chairs all in good repair. There are cubbies available inside classrooms for storing children’s belongings. All trash containers have tight fitting lids. School bathrooms are on site and located inside church. There are two bathrooms with working toilets and sinks with no hot water. Facility uses school playground which is located outside portable. Blacktop areas is equipped with canopy for shade and table/bench and a pickle ball net. There is a play cart available with balls, skateboards, helmets, paddles, and other age-appropriate equipment. Playground flooring is all blacktop. There are no spas, pools or other bodies of water located outside. After school program provides snacks for children. Food is properly stored and labeled in cabinets for freshness and to avoid contamination. Children bring their own labeled water bottles and school provides Brita filtered water for children. There is a fully equipped first aid kit located in classroom with all necessary supplies. Incidental Medical Services were discussed, Isolation area for sick children is in school office and away from other children. All cleaning products, chemicals, and toxins are inaccessible to children and locked in storage cabinets and out of reach of children. LPAs reviewed Brightwheel sign in/out sheet app. Parents sign children in and out in the morning/afternoon. After school care children are signed in by staff. Classroom is equipped with smoke alarm system, working carbon monoxide detector, and fully charged fire extinguisher. Facility uses cell phones to communicate with each other and use the Brightwheel app for communication. Cont. on page 2…

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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: REDWOOD CHURCH AFTER-SCHOOL CHILD CARE	FACILITY NUMBER: 414004915
	VISIT DATE: 10/11/2023

NARRATIVE

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LPAs reviewed 5 children’s records and 2 staff record. All children’s records were complete and up to date. Staff records were missing documents, LPA’s reminded Director to keep staff files up to date. LPAs observed one staff to be missing fingerprint clearance, See 809D page for deficiency. The facility has all necessary paperwork posted, Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Per Director, last emergency drill was conducted August. LPAs reminded Director to document emergency drills. Per Director there are no firearms or weapons on site.

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/.

Director 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.

The Director was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

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.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Cont. page 3...

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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: REDWOOD CHURCH AFTER-SCHOOL CHILD CARE	FACILITY NUMBER: 414004915
	VISIT DATE: 10/11/2023

NARRATIVE

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LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

One type B deficiency was cited today, see page 809D.

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 conducted and report was reviewed with the Director, Kareena Campbell.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/11/2023 03:45 PM - It Cannot Be Edited

Created By: Maria Olguin-Leon On 10/11/2023 at 03:25 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: REDWOOD CHURCH AFTER-SCHOOL CHILD CARE	FACILITY NUMBER: 414004915
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in one person does not have fingerprint clearance, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/12/2023
	Plan of Correction
1 2 3 4	Director will have staff fingerprint cleared before retuning to work with children.

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:

Maria Olguin-Leon

LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC809 (FAS) - (06/04)

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