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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004929
Report Date: 08/08/2022
Date Signed: 08/08/2022 10:22:55 AM

Document Has Been Signed on 08/08/2022 10:22 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:NEWTON @ PARKFACILITY NUMBER:
414004929
ADMINISTRATOR:TAMIR, TALFACILITY TYPE:
840
ADDRESS:161 CLARK DRIVETELEPHONE:
(650) 345-4043
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tal TamirTIME COMPLETED:
10:30 AM
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On August 8, 2022 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a pre-licensing inspection. LPA met with operations manager, Tal Tamir, and explained the purpose of the inspection. The applicant is requesting a school age license for 30 children (Tk to 5th grade). The facility will operate Monday through Friday from 1:05pm to 6:00pm and Wednesdays 12:40pm to 6:00pm.

The after school program will operate on Park Elementary school site of San Mateo Foster City school district. The designated site supervisor will be Aleena Asaou. The facility was inspected, indoors and outdoors, for health and safety hazards.

Indoors: 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. The program will operate out of portable classroom #37 only. Classroom is equipped with appropriate furniture that is in good working condition. Storage for children's belongings are available outside the classroom. LPA observed classroom is equipped with at least 1 working carbon monoxide detector. Entire facility has a fire alarm system installed and implemented. Classroom is equipped with age appropriate toys and materials, multiple fully stocked first aid kits and a fully charged fire extinguisher. Medications with required documents and emergency supplies will be stored in an emergency backpack that is brought from indoors to outdoors.

All toxins and hazardous items will be stored in locked cabinets, inaccessible to children. Isolation for a sick child will be in the classroom, separate from other enrolled children. Restroom is located in the classroom that allows for individual privacy. Restroom was observed to be clean and in proper working condition. Program will use school district garbage cans and bins that will be disposed of daily by school district site's janitorial services.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: NEWTON @ PARK
FACILITY NUMBER: 414004929
VISIT DATE: 08/08/2022
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Program will provide dry, afternoon snacks only. Operations manager is aware food is not to be stored near toxins and poisons. Water is accessible to enrolled children with multiple accessible water fountains and a refillable water station.

Outdoors: The entire outdoor area of the school is enclosed by a fence that is at least four feet tall. Separate after school program will also operate on elementary school site that is separate from Newton program. Program as exclusive use of 2 playgrounds with playground structures located on school site. LPA observed playgrounds to be clean, safe and equipped with climbing structures appropriate for children's age group. Resilient padding is installed under climbing, play structures. Operations manager is aware enrolled children using the playgrounds will always be supervised and monitored.

Operations manager is aware disaster drills are to be conducted at least once every six months and properly logged and maintained. All required licensing documents and posters will be maintained in Newton binder, on site, available for review.

Operations manager was 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.

LPA reviewed with operations manager 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

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/08/2022
LIC809 (FAS) - (06/04)
Page: 3 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: NEWTON @ PARK
FACILITY NUMBER: 414004929
VISIT DATE: 08/08/2022
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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.

During visit, LPA received:
-Revised and updated application
-Revised and updated facility responsibility
-Updated facility sketch
-Revised and updated health screening report for site supervisor
-Updated 16 hours of preventative health for site supervisor

After today's visit, LPA will approve for a provisional license effective today's date, for requested capacity of 30 children.

LPA will recommend a regular license for facility once following is approved:
-Submission of MOU.

Exit interview conducted and report was reviewed with operations manager, Tal Tamir.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/08/2022
LIC809 (FAS) - (06/04)
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