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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410503311
Report Date: 08/22/2024
Date Signed: 08/22/2024 03:13:35 PM


Document Has Been Signed on 08/22/2024 03:13 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:MILLBRAE NURSERY SCHOOL, INCFACILITY NUMBER:
410503311
ADMINISTRATOR:BOGNI-RODRIGUEZ, MEGANFACILITY TYPE:
850
ADDRESS:86 CENTER ST.TELEPHONE:
(650) 589-3028
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:44CENSUS: 18DATE:
08/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Megan Bogni-RodriguezTIME COMPLETED:
03:40 PM
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On August 22nd, 2024 at approximately 8:30am, Licensing Program Analysts (LPAs) Tapia-Mandujano and Basak arrived at the facility. LPAs met with Director, Megan Bogni-Rodriguez. The purpose of inspection was explained, and it was an announced Case Management inspection to add a Toddler Component into existing Preschool license. Per Director, children did a "meet the teacher" half day. Present during inspection were 18 preschool age children being supervised by 13 staff. Not all staff present were fingerprint cleared.

Facility has request to add 15 toddlers into the existing preschool license of 44. Facility is aware that they cannot exceed more than 12 toddlers (ages 18m-36m) in the Toddler classroom. Preschool classroom will be for 29 children. LPAs remeasured both toddler and preschool indoor spaces.

Facility consists of two classrooms: Smaller classroom on the far end will be for Toddlers, and bigger classroom towards the front of the building will be for Preschoolers. Toddler classroom total useable indoor square footage is 883.459 divided by 35sqft equals to 25 children exceeding desired capacity. Toddler Classroom has a restroom with two toilets, two sinks, and a pull-down changing table for exclusive use for Toddlers.

LPAs observed toddler classroom to be clean and equipped with age-appropriate toys and materials. Storage for children's belongings are located inside the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system inside the classrooms as well as a fully charged, fire extinguisher. The classrooms has a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials.

Toddlers will use the left side of the outdoor yard and come out at specific times to not comingle with preschool age children. Outdoor areas consist of the grass area, bike trail/cement area, and the left side of the tanbark area. Preschool swing structure will be off limits for toddlers. Total useable outdoor square footage is 2,448.078 divided by 75sqft equals to 32 children exceeding the desired capacity.

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SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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: MILLBRAE NURSERY SCHOOL, INC
FACILITY NUMBER: 410503311
VISIT DATE: 08/22/2024
NARRATIVE
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LPAs observed outdoor area to be clean and equipped with age-appropriate toys and materials. There is no physical barriers to divide the allowed use of toddler spaces. Facility will ensure that toddlers do not use the right side of outdoor playground that contains structures, toys, and materials that may not be safe for toddler ages. There is shading throughout the outdoor spaces.

Preschool Room total useable indoor square footage for 1208.473 divided by 35sqft equals to 34 children exceeding desired capacity. Preschool classroom has a restroom with two toilets, two sinks, and a pull-down changing table for exclusive use of preschool children.

LPAs observed classroom to be clean and equipped with age-appropriate toys and materials. Storage for children's belongings are located inside the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system inside the classrooms as well as a fully charged, fire extinguisher. The classrooms has a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials.

Preschoolers will use the entire outdoor yard during times that toddlers are not outside. LPAs remeasured the outdoor space total useable outdoor square footage for 7,779.126 divided by 75sqft equals to 103 children exceeding desired capacity. LPAs observed outdoor area to be clean and equipped with age-appropriate toys and materials. There is shading throughout the outdoor spaces.

During the inspection, LPAs received the following updated/corrected documents that were requested: LIC 200A, LIC 999A, LIC 610A, LIC 500, LIC 309, Admission Agreement, Parent Handbook, Job Description for Toddler teacher, Daily Schedule, Director forms-Orientation certificate, CPR certificate, unofficial transcripts, Lead results with floor map, Shared Space/Rotational waiver request, and an LIC 9182, transfer request.

During inspection, LPA Basak walked around to verify teachers had fingerprint clearance cross-referencing the Guardian list and observed that there were 2 staff that have gotten fingerprints but have not been fully cleared. Type A deficiency will be cited.

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SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
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: MILLBRAE NURSERY SCHOOL, INC
FACILITY NUMBER: 410503311
VISIT DATE: 08/22/2024
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This facility provides Incidental Medical Services – IMS. Facility will develop a plan and submit to department. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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/.

Licensee [or facility representative] 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.

Prior to approving the toddler component, the following corrections must be submitted:
*Toddler Room- Pet food inaccessible to children
*Outdoor Area- Food cabinet to be locked or inaccessible to children
*Outdoor Area- Sandbox to be fully covered
*Documents that are missing are: updated Personnel Handbook, Preschool and Toddler Daily routine schedules

LPAs informed Director, Megan Bogni-Rodriguez that this report dated 08/22/24 documents a Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the Director, Megan Bogni-Rodriguez to provide a copy of this licensing report dated 08/22/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


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

Exit interview conducted and report was reviewed with Director, Megan-Bogni-Rodriguez. Appeal Rights were provided.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/22/2024 03:13 PM - It Cannot Be Edited

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: MILLBRAE NURSERY SCHOOL, INC
FACILITY NUMBER: 410503311

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2024
Section Cited
CCR
101170(e)(1)

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101170(e)(1): All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department. This evidencie is not met by evidence by:
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During Inspection, LPAs checked the guardian system and there were two staff that fingerprint clearance did not clear.

Staff left during the inspection.
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Based on interview and record review, the licensee did not comply with the section cited above as there were two staff that were not fingerprint cleared which poses an immediatel health, safety or personal rights risk to persons in care.
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Staff cannot return until fingerprnts are cleared and associated to the facility.

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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 RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4