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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213002273
Report Date: 06/26/2024
Date Signed: 06/26/2024 03:12:57 PM

Document Has Been Signed on 06/26/2024 03:12 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:LITTLE SCHOOL- TIBURON, THEFACILITY NUMBER:
213002273
ADMINISTRATOR/
DIRECTOR:		DOBRIN, HEATHERFACILITY TYPE:
850
ADDRESS:11 SHEPHERD WAYTELEPHONE:
(415) 435-3521
CITY:TIBURONSTATE: CAZIP CODE:
94920
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 14DATE:
06/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:44 PM
MET WITH:Heather DobrinTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On June 26, 2024, Licensing Program Analyst (LPA) Nathan Garcia met with director, Heather Dobrin for an unannounced annual inspection of the preschool facility. Purpose of the inspection was explained. Present in the facility are 3 staff members including the director, supervising 14 children. Facility is operating within its capacity and is in compliance with staff/child ratio on this day. Facility operates day care Monday - Friday 8:15am to 2:15pm.

LPA inspected day care areas and the outdoor space. LPA observed facility has combined smoke detectors and carbon monoxide detectors, LPA tested the functionality of the detectors. Multiple fully charged fire extinguisher model 3A40BC located on multiple areas and in each rooms. The facility has a working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards.

There are first aid supplies available in the classrooms and in the office. All bathrooms are in working condition. All food is stored properly to avoid contamination. Facility has enough sleeping cots/mats available. Individual items provided by the parents are labeled and stored appropriately.

According to Heather, all snacks and lunches are brought from home. Per Heather, the children are provided through water services dispenser as main source of drinking water, refilled as needed and water bottles are brought from home. Food is stored adequately to prevent contamination and properly labeled. There is water available for children in the yard as well as in the classrooms and emergency bags.

LPA observed outdoor area and play structures are free from health and safety hazards. There are sand boxes, checked after each use. The outdoor area has play structures, and shaded areas for the children to rest. There are a variety of bicycles and sports equipment available for the children. There are also sheds/bins and storage areas for the toys when they're not being used.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LITTLE SCHOOL- TIBURON, THE
FACILITY NUMBER: 213002273
VISIT DATE: 06/26/2024
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CHILD CARE CENTER RECEIVED ACKNOWLEDGEMENT OF ATTESTATION LETTER


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).

Attestation letter is acknowledged and on file LPA observed the water dispensers and fully stocked water refills on site.

According to Heather, the facility is using paper for sign in/out. Facility has license and all other required documents posted and visible for the public. Based on record review and interview, the facility's most recent emergency drill was October 2023. LPA reminded the director to complete emergency drills at least 2 times a year.

LPA reviewed the facility records. LPA reviewed 3 children's files during the visit. LPA reviewed 3 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. Based on LPA's records review, 2 teachers did not have health screening report in their files.



The Director was reminded that all adults 18 and over, 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 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.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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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: LITTLE SCHOOL- TIBURON, THE
FACILITY NUMBER: 213002273
VISIT DATE: 06/26/2024
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Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file.
LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

According to director, there are no children with allergies. Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS informationDocument Link Icon see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

Type B Deficiency for missing health screening reports for staff.

A copy of this report was given and the “Notice of Site Visit” to director.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed by director, Heather Dobrin.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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Document Has Been Signed on 06/26/2024 03:12 PM - It Cannot Be Edited


Created By: Nathan Garcia On 06/26/2024 at 03:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: LITTLE SCHOOL- TIBURON, THE
FACILITY NUMBER: 213002273

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review)], the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2024
Plan of Correction
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The director will submit health screening reports of staff member for verification by set due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024


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