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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005122
Report Date: 10/29/2024
Date Signed: 10/29/2024 01:26:12 PM

Document Has Been Signed on 10/29/2024 01:26 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 INFANT TODDLER CENTERFACILITY NUMBER:
414005122
ADMINISTRATOR/
DIRECTOR:		AUDRA TSIVIKASFACILITY TYPE:
860
ADDRESS:300 EL CAMINO REALTELEPHONE:
(650) 593-2005
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: DATE:
10/29/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Applicant Audra Tsivikas and Director Alexandra MirandaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Jamel Maiwandi met with Applicant Audra Tsivikas and Director Alexandra Miranda for the purpose of an announced pre-licensing change of ownership inspection at 300 El Camino Real San Carlos, CA, 94070. This is a change of ownership from Happy Campers Infant Toddler Center 414004062 to Happy Campers Infant Toddler Center 414005122. Applicant requests an infant and toddler license to serve 32 infant children from birth to two years of age and 12 toddler children from ages 18 months to 36 months. The program will operate Monday through Friday from 8:00am to 5:30pm. The fire clearance was granted on 7/9/2024. The facility will provide a morning snack, lunch and afternoon snack time.

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 three infant classrooms (Busy Bees, Crickets, Sweet Potato Bugs) and one toddler classroom (Butterflies) located in the facility, and a staff office room which will serve as the isolation area for sick children. The food preparation area is located next to the entrance to the outdoor activity area and is inaccessible to children. Staff was reminded that all kitchen, food preparation and storage areas shall be kept clean and free of litter and rubbish; and measures shall be taken to keep all such areas free of rodents and other vermin. LPA measured the classrooms which includes a total of 1531.41 square feet and will accommodate the applicants request for 32 infant children and 12 toddler children. LPA observed a sufficient number of tables, chairs, and cubbies for 32 infants and 12 toddlers. LPA observed 20 cribs and 24 napping cots/mats. LPA observed a variety of age-appropriate toys and equipment. Applicant acknowledges there will be a maximum of 32 infants under 24 months old, due to available cribs.

report continues on LIC 809 page 2
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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 4
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 INFANT TODDLER CENTER
FACILITY NUMBER: 414005122
VISIT DATE: 10/29/2024
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There is a first aid kit located in each classroom and in the food preparation area as well. Medications will be stored in the main office area and inaccessible to children. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated drinking water will be provided via filtered water and will be provided by parents as well. LPA observed a functional carbon monoxide detector in the main hallway. Applicant stated they will use a digital sign-in/sign-out system and paper system as well as back up. Parents will provide sheets, blankets, and pillows. There is a total of two toilets and two sinks available for toddler children. There is one staff restroom located next to the outdoor activity area. There is a dedicated mobile line for the facility with applicant Audra Tsivikas. Applicant Audra Tsivikas and Director Alexandra Miranda were informed facility shall be kept clean, safe, sanitary and in good conditions at all times to ensure the safety and well-being of children, employees and visitors.

LPA provided and discussed Health and Safety Code 1596.956 regarding the toddler option with Applicant.

OUTDOOR ACTIVITY SPACE:

There is one outdoor play area located at the facility. The outdoor play area contains a total of 1,501 square feet and will not accommodate the applicants request for 32 infant children and 12 toddler children. LPA observed a sufficient amount of toys, play equipment, and multiple play structures that are appropriate for ages 12 months and up as per Director Alexandra Miranda. LPA observed sufficient resilient padding located in the designated outdoor play area. The outdoor play area is fenced by a grey metal fence that is at least four feet tall. There is an emergency exit located in the outdoor play area which is locked from the outside and can only be opened from the inside by staff. Staff was reminded that the gate shall remain closed at all times during hours of operation to ensure the health and safety of children in care. There is sufficient shade for the outdoor play area provided by surrounding trees and a gazebo. There are no bodies of water located on the premises

Report continues on LIC 809 page 3

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 INFANT TODDLER CENTER
FACILITY NUMBER: 414005122
VISIT DATE: 10/29/2024
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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) 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.

Staff were 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.

Staff were 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.

Report continues on LIC 809 page 4
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 INFANT TODDLER CENTER
FACILITY NUMBER: 414005122
VISIT DATE: 10/29/2024
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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.

Assembly Bill (AB) 2370, /chapter 676, Statues 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-year 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)

Exit interview conducted and report was reviewed with applicant Audra Tsivikas and Director Alexandra Miranda.

The following is required before a license will be issued:

Department review of pending document corrections


SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4