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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005119
Report Date: 07/11/2024
Date Signed: 07/11/2024 01:34:33 PM

Document Has Been Signed on 07/11/2024 01:34 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:HAPPY CAMPERS PRESCHOOL DAYCARE, INC.FACILITY NUMBER:
414005119
ADMINISTRATOR/
DIRECTOR:		AUDRA TSIVIKASFACILITY TYPE:
860
ADDRESS:1225 GREENWOOD AVENUETELEPHONE:
(650) 593-2005
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 0DATE:
07/11/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Audra TsivikasTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Applicant Audra Tsivikas for the purpose of a pre-licensing inspection. Applicant requests a preschool license to serve 50 preschool children from age two to entry into kindergarten. The program will operate Monday through Friday from 8:00 a.m. to 5:30 p.m. The fire clearance was granted and received on 6/21/2024. Parents will provide all meals for their children.

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.

INDOOR ACTIVITY SPACE:
There are four preschool classroom areas (Preschool Main Room, Changing Room, Library Room, and Construction Room). LPA observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in the cabinet kitchen. Medications will also be stored in the kitchen cabinet. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated parents will provide individual water bottles that will be refilled throughout the day. LPA observed a functional carbon monoxide detector in the kitchen. LPA observed an electronic sign-in/sign-out system.

LPA measured the classroom spaces. The total classroom spaces contain a total of 2,292 square feet, which will accommodate Applicant's request for 50 preschool children. There are four toilets and four sinks located in the preschool bathroom in the main room and three portable sinks located in the changing room for the children. There is a separate private restroom for the staff located in the preschool changing room. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated near the kitchen and main room and will use the staff restroom, if necessary.

Report continues on LIC809-C page 2.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HAPPY CAMPERS PRESCHOOL DAYCARE, INC.
FACILITY NUMBER: 414005119
VISIT DATE: 07/11/2024
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OUTDOOR ACTIVITY SPACE:
There is one large outdoor area on the property plus an addition outdoor sensory area. The outdoor play area is fenced with a wooden fence that is at least four feet tall. LPA observed a sufficient amount of equipment and toys. There is a play structure which is designated use for children 2 to 5 years old. There are no bodies of water on the premises. There are shaded areas supplied by a large overhang at the end of the yard and on both sides.

LPA measured the outdoor activity space. The outdoor play area contains a total of 7,632 square feet, which will accommodate Applicant's request for 50 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

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) or (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 discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues LIC809-C page 3.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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: HAPPY CAMPERS PRESCHOOL DAYCARE, INC.
FACILITY NUMBER: 414005119
VISIT DATE: 07/11/2024
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Applicant 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, 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.

Applicant was informed of the MyChildCarePlan.org site, 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.

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 Audra Tsivikas.

LPA will issue a provisional license that will expire in 90 days on 10/9/2024. Once the provisional is issued, the following items are to be submitted prior to expiration of the provisional license for final approval of a regular license:



1. Remaining documents listed on the NOIA (LIC184C).
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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