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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004917
Report Date: 08/11/2022
Date Signed: 08/11/2022 11:34:43 AM

Document Has Been Signed on 08/11/2022 11:34 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:WESTLAKE ELEMENTARY SCHOOLFACILITY NUMBER:
414004917
ADMINISTRATOR:BUGANTE, KRISTINEFACILITY TYPE:
850
ADDRESS:80 FIELDCREST DRIVETELEPHONE:
(415) 370-3945
CITY:DALY CITYSTATE: CAZIP CODE:
94015
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
08/11/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lisa ZimigaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted a scheduled pre-licensing inspection and met with Applicant Lisa Zimiga. Applicant is requesting a capacity of 24 preschool aged children (ages 2 years old to entry into kindergarten. School has a TK class onsite.). The facility will operate from Monday to Friday from 8:00 am to 3:00 pm. The designated director/site supervisor for the facility will be Kristine Bugante. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: Preschool is located in classroom 4 at Westlake Elementary School. Total useable indoor square footage is 872.90 sq ft divided by 35 sq ft equals 24 children. There is a total of nine toilets, four urinals, and ten sinks accessible for children's use. Total allowable capacity for toilets is 195 and sinks is 150 .

Classroom is observed today to be clean and all furniture, toys, and equipment observed to be safe and in good condition. There is storage space for children's personal belongings and cots to be utilized for napping children. There is a fire alarm system throughout the school. Classroom is equipped with a fire extinguisher and smoke and carbon monoxide detectors. Garbage cans have tight-fitting lids. First aid kit and emergency supplies are located in the classroom inaccessible to children. The facility is adequately ventilated.

There are two bathrooms located adjacent to the classroom. One bathroom has five toilets and four sinks. Another bathroom has three toilets, four urinals, and four sinks. There is also another bathroom located inside the library with one toilet and one sink that is next to the playground. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees. There is a separate bathroom for staff usage on the premises. Drinking water is available for the children indoors and outdoors. All toxins and other hazardous items will be stored inaccessible to children. Isolation of ill children will be in the sick bay of the main office. Bathroom located in the office will be used for an ill child.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
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: WESTLAKE ELEMENTARY SCHOOL
FACILITY NUMBER: 414004917
VISIT DATE: 08/11/2022
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Facility will provide breakfast and lunch through the school district's food service that will be delivered daily. Menu will be posted in the classroom. Medications will be stored in the main office. Required postings were observed during today's inspection and will be placed on the classroom's windows facing out for parents to see.

Outdoor: There will be two outdoor areas for preschool use. Preschool playground measures 2,121.67 sq ft. divided by 75 sq ft allowing for a total of 28 children. The outdoor area is enclosed with a four foot fence and observed to be clean, safe and equipped with age appropriate toys and equipment for children. Play structure is age appropriate for children in care. Resilient material is located underneath the play structure. Second outdoor play area outside of classroom measures 3,058.65 sq ft divided by 75 sq ft allowing for a total of 40 children. Play area is enclosed in between classrooms. Teachers will bring out a Brita filtered water pitcher and disposable Dixie cups while outside. Shade for children will be provided by shade awnings from the classrooms. Outdoor play areas will be shared with TK classroom. Applicant will submit a waiver request and provide an outdoor rotation schedule.

LPA will approve a provisional license of facility for the capacity of 24 children as of today, August 11, 2022. LPA will approve full licensure once LPA has received all requested documents from LIC 184. Fire clearance inspection was conducted by fire inspector on July 1, 2022 and requested capacity was granted.

Applicant was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
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)
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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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: WESTLAKE ELEMENTARY SCHOOL
FACILITY NUMBER: 414004917
VISIT DATE: 08/11/2022
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Lisa Zimiga.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
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)
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