414004917-3-6-2024-05-CC-CQUO-D34QCT-20240306110341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004917
Report Date: 03/06/2024
Date Signed: 03/06/2024 11:03:53 AM

Document Has Been Signed on 03/06/2024 11:03 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:	WESTLAKE ELEMENTARY SCHOOL		FACILITY NUMBER:	414004917
ADMINISTRATOR:	BUGANTE, KRISTINE		FACILITY TYPE:	850
ADDRESS:	80 FIELDCREST DRIVE		TELEPHONE:	(415) 370-3945
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 20	CENSUS: 18	DATE:	03/06/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Kristine Bugante		TIME COMPLETED:	11:15 AM

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 March 6, 2024 at approximately 8:20am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. Preschool program operates at Westlake Elementary School in Classroom #4 only. LPA met with site supervisor, Kristine Bugante, and explained the purpose of the visit. Present during LPA's visit included site supervisor, 2 teaching assistants and 18 preschool children. Preschool program is operating within capacity limits and ratio during LPA's visit. All staff working in classroom are fingerprinted through Jefferson elementary school district. Hours of operation are Monday through Friday 8:00am to 2:30pm. With site supervisor, LPA inspected facility, indoors and outdoors, for health and safety hazards. LPA observed preschool classroom to have a variety of toys and materials that were in good working condition. Children's furniture and equipment were observed to be age appropriate. There are carpets in the classroom that were observed to be clean. There are multiple activities in the classroom that children have access to that were observed to be age appropriate. There is sufficient storage for children's belongings located inside the classroom, labeled with children's individual names. Accessible cabinets and drawers in classrooms were not observed to have any hazardous materials or poisons stored. LPA observed poisons, cleaning solutions and chemicals were stored in classroom's high shelves, inaccessible to children. Classroom is equipped with a fully charged fire extinguisher, an emergency backpack and a fire alarm system implemented by school district. There is a carbon monoxide detector in the classroom that was tested during visit. LPA observed carbon monoxide detector to be in working condition. There is a sink in the classroom that children have access to. Sink was observed to be in working condition and does not provide water that is warmer than 120 degrees Fahrenheit. Sink in classroom also includes a water fountain that children are able to drink from. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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: WESTLAKE ELEMENTARY SCHOOL	FACILITY NUMBER: 414004917
	VISIT DATE: 03/06/2024

NARRATIVE

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Cots are appropriately stored and stacked in the classroom. Children's sheets and blankets were observed to not be touching. Per site supervisor, sheets and blankets are laundered weekly by children's families, cots are sanitized weekly by teaching staff.

Preschool program shares the school district bathrooms with the elementary school. Children are walked to and from the preschool classroom to the shared restroom. Per site supervisor, elementary school children do not use the shared restroom while preschool children use the shared restroom. LPA observed bathrooms to be clean and in working condition. Garbage bin in bathrooms were observed to have tight fitting lids.

Preschool program has access to two playgrounds. Playground #1 is shared between preschool program and elementary school TK program. Per site supervisor, preschool program and TK children do not use the outdoor area simultaneously. LPA observed outdoor area to be fully fenced and enclosed. There is a play structure in the outdoor area that includes resilient padding underneath.

While children are in the outdoor area and need to use the restroom, children have access to restroom located in school district library. Children playing in the outdoor area also have access to the water fountain located in library. Additional playground/court preschool program has access to is located directly outside classroom #4. Outdoor area includes outdoor toys and materials that were in good condition. LPA did not observe any bodies of water on site.

Drinking water is available to preschool children, both indoors and outdoors, with water pitchers that are refilled on site through classroom sinks and/or drinking fountains.

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.

Per site supervisor, they are unsure as to when facility completed lead water testing but believe school district completed testing. LPA referred site supervisor to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Program provides a food service that is prepared in school district cafeteria and brought to preschool classroom. LPA observed program to utilize a paper sign in/out system that is located in the classroom. LPA also observed licensing documentation and posters to be properly posted in classroom, available for review.
(Continue Report on Page 3...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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: WESTLAKE ELEMENTARY SCHOOL	FACILITY NUMBER: 414004917
	VISIT DATE: 03/06/2024

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During today's visit, LPA reviewed six random children's files. Children's files were complete with a record of required immunizations, emergency and admission information. Site supervisor has a current CPR/First Aid certification that will expire 12/2025.

Site supervisor 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.

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/

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

Site supervisor was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Facility was cited a Type B citation for not completing lead testing requirements by due date of January 1, 2023. A plan of correction was discussed and appeal rights were provided during visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with site supervisor, Kristine Bugante.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/06/2024 11:03 AM - It Cannot Be Edited

Created By: Catrina Quimbo On 03/06/2024 at 10:29 AM

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: WESTLAKE ELEMENTARY SCHOOL	FACILITY NUMBER: 414004917
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. 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 by not completing lead testing by January 1, 2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/08/2024
	Plan of Correction
1 2 3 4	Facility to test their water fixtures used for drinking and food preparation no later than POC due date. LPA reminded site superivosr testing must be completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA remindedsite supervisor lead testing must be completed by an ELAP certified laboratory.

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:

Catrina Quimbo

LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC809 (FAS) - (06/04)

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