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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213001117
Report Date: 03/06/2024
Date Signed: 03/06/2024 04:03:20 PM

Document Has Been Signed on 03/06/2024 04:03 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:JCC PRESCHOOL SAN RAFAELFACILITY NUMBER:
213001117
ADMINISTRATOR:RACHEL WEISSFACILITY TYPE:
850
ADDRESS:200 N. SAN PEDRO ROADTELEPHONE:
(415) 444-8044
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 41DATE:
03/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Amanda McAdamsTIME COMPLETED:
04:18 PM
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On 3/6/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced required visit to the child care center listed above. During today’s visit, the LPA met the facility representative, Amanda McAdams. The facility representative was informed of the reason for today's visit by the LPA. During today's visit, forty-one preschool-aged children were present in the center. Present in the center with fingerprint clearance included the facility representative and sixteen staff members. The center is operating within its capacity and in accordance with the required ratio of staff to children.

The LPA and the facility representative conducted an inspection to identify any potential health and safety hazards. The LPA observed that the center maintains an electronic record of the children’s attendance, with corresponding parental signatures, and all enrolled children are accounted for during the day. The LPA observed that a fully stocked first aid kit was available during today’s visit. The LPA observed that the classrooms had age-appropriate toys, furniture, and educational materials. The LPA identified that the equipment and furniture in the outdoor playground appeared to be in excellent condition. The LPA observed that the center has a fish pond at the entrance that is properly secured with a cover. All cleaning and washing products, along with any other harmful materials, are kept out of children's reach. The center has smoke detectors, carbon monoxide detectors, fire extinguishers, centralized smoke alarms, and operational phones. According to the facility representative, no firearms or other weapons are kept in the center. The LPA observed that the center provides lockers and cubbies for the children in care. The LPA observed that the children bring their own water bottles, and each of them is properly labeled with their names.

The LPA observed a designated area for children to sleep or rest quietly. The area includes mats and blankets for each child. The LPA also observed three diaper-changing stations in the center, which were clean and safe for the children. Baby wipes and diapers were available for the children in care.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: JCC PRESCHOOL SAN RAFAEL
FACILITY NUMBER: 213001117
VISIT DATE: 03/06/2024
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The LPA observed that all required documents, such as the facility license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities, were displayed in the center. The center’s most recent emergency disaster drill was conducted on 10/15/2023 and was properly recorded, as confirmed by the LPA's review of the log.

The LPA reviewed the records of both the children and staff members. The LPA reviewed the files of the five children and confirmed that their Immunization Record, Admission Agreement, Personal Rights Identification and Emergency Information, Physician's Report, Notification of Parents' Rights, and Consent for Emergency Medical Treatment were included in their records. The LPA reviewed the records of the five staff members and confirmed that all five were not current with their Pediatric First Aid/CPR certification. The LPA confirmed that the facility representative's Pediatric First Aid/CPR certification is current. The LPA confirmed that all five staff members completed their twelve units for Early Childhood Education, qualifying them as teachers. The LPA reminded the facility representative that they should have the staff's immunization records and TB test results on file.

Assembly Bill (AB) 2370, Chapter 676, Statutes 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-years 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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

The 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.

LPA discussed the safe sleep regulations with the facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed the facility representative 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.
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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: JCC PRESCHOOL SAN RAFAEL
FACILITY NUMBER: 213001117
VISIT DATE: 03/06/2024
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This facility provides Incidental Medical Services – IMS. 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-carecenters/

Facility representative was informed of the MyChildCarePlan.org website; 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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process



No deficiencies were issued today during LPA's visit.

A copy of today’s report was given to Amanda McAdams.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Amanda McAdams

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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