Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410519011
Report Date: 08/02/2019
Date Signed: 08/02/2019 01:09:20 PM

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:CSSF REC DEPT-PONDEROSA AFTER SCHOOL REC PROGRAMFACILITY NUMBER:
410519011
ADMINISTRATOR:CRISTINA RODRIGUEZFACILITY TYPE:
840
ADDRESS:295 PONDEROSA ROADTELEPHONE:
(650) 873-1096
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:120CENSUS: DATE:
08/02/2019
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Laura Armanino, TIME COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Andrea Medlin met with recreation and community services supervisor for this case management visit due to a request to increase capacity. Facility is licensed to serve school aged children on the Ponderosa Elementary School campus and currently operates the school age program in portables #19, #20, #21 and requesting to add portable #18 for an additional 40 children. South San Francisco Fire Department has approved the fire clearance on 7/26/19. Days and hours of operation for the school aged program vary based on dismissal times: Monday-Friday 7:30AM-6:00PM. Superintendent certification is on file and this is a functioning school site, therefore facility is exempt from the following: indoor square footage, fencing, outdoor activity space, toilets, and isolation space requirements. Physical plant toured, including the areas used for the program, and outdoor play areas to inspect for health and safety hazards. There are fully charged fire extinguishers that meet minimum requirements, smoke detectors, and carbon monoxide (CO) detectors present in each portable. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. A separate staff bathroom is available. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per staff, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available in the facility. Facility provides snacks. First aid supplies are available. There are school aged outdoor play areas. The areas around and under high climbing equipment is cushioned with soft rubber. Outdoor activity space surfaces are free of hazards. Facility has posted all the required licensing forms. This facility meets the licensing requirements to increase capacity to 160 children and re-licensure is recommended and approved as of today, 8/2/2019. New license shall be posted when received. This report is reviewed with recreation and community services supervisor and a copy of this report must made be available for public review upon request.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2019
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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