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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700603
Report Date: 02/18/2022
Date Signed: 02/18/2022 02:45:09 PM

Document Has Been Signed on 02/18/2022 02:45 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ST TIMOTHY'S PRESCHOOLFACILITY NUMBER:
430700603
ADMINISTRATOR:STACEY SULLIVANFACILITY TYPE:
850
ADDRESS:2094 GRANT ROADTELEPHONE:
(650) 967-4724
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 22TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
02/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Stacey SullivanTIME COMPLETED:
02:40 PM
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On 02/18/2022 at approximately 12:15pm, Licensing Program Analyst (LPA) Sabina Dodoo and Licensing Program Manager (LPM) Chandra Charles met with Director Stacey Sullivan for an UNANNOUCED ANNUAL REQUIRED INSPECTION for St. Timothy’s Preschool. Present for the inspection were the Director and one staff member who are all fingerprint cleared. The total children enrolled are 11 and the census was 9 at the time of the inspection. The Child Care Center is within ratio. The Child Care Center was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 8:30am to 3pm.

The Preschool is located on a campus next to a church. There are 3 classrooms: Room 8, Room 9 and Room 10 which are licensed by CCLD. Room 8 and 9 are the activity classrooms. There are arts and craft materials and books for learning. Room 10 is where the bathrooms are located and it is also a relaxation area. There are cubbies with the children’s names on them. The entrance of the Preschool is a small gate where the parents do curbside drop off and pick up. The teachers do temperature checks of each child prior to having them come into the school. The parents sign in and out on paper. LPA (Dodoo) and LPM (Charles) observed the outdoor activity areas to be neat with proper ventilation and materials equipped to care for the children. LPA (Dodoo) and LPM(Charles) observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills and facility license). The children bring lunch and snack from home and have water bottles with their names on them. Lunch is brought from home. There are no bodies of water on the premises. There are no firearms on premises. All chemicals are kept out of reach of the children. LPA Dodoo observed two children’s bathrooms that are operable.
The OFF-LIMIT AREAS are: Room 1 through Room 7.
The ON-LIMIT AREAS are: Room 8, Room 9, Room10 and the play yard.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ST TIMOTHY'S PRESCHOOL
FACILITY NUMBER: 430700603
VISIT DATE: 02/18/2022
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All hazardous materials and toxins are kept out of reach from children and are not accessible. The Child Care Center has one fully charged fire extinguisher 3A-10- 40 BC, multiple working smoke detectors, multiple working carbon monoxides, telephone and fully stocked first aid kits. The furniture around the classrooms and outdoor activity area are all child proof and adequate for children to use. The learning materials are organized, and toys are kept in safety bins and cabinets for easy access for the children.

The Director and staff have completed the Health and Safety training and CPR/First Aid is current. The Director and Staff are following the immunization laws and have completed the mandated reporter training. The Director has conducted and documented the fire and disaster drills once a month and the last conducted drill was on February 12 of 2022. All required forms are posted and visible for public view.

At 1:30pm LPA(Dodoo) reviewed 4 children’s files and 2 staff files (Director file included) and documented them on LIC 857 and LIC 859. An updated roster was viewed by LPA Dodoo and LPM Charles. A copy was obtained from Director. The staff interview was completed with Director Stacey Sullivan.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children currently. If any IMS is provided, a Plan for Providing 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ST TIMOTHY'S PRESCHOOL
FACILITY NUMBER: 430700603
VISIT DATE: 02/18/2022
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Director was reminded that all adults 18 and over working in Child Care Center, 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 licensed 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 discussed the safe sleep regulations with licensee 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 licensee 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.

Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Director (Stacey Sullivan). This report shall remain on file for the next 3 years.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Sabina Dodoo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC809 (FAS) - (06/04)
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