<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005477
Report Date: 01/18/2024
Date Signed: 01/18/2024 03:49:53 PM

Document Has Been Signed on 01/18/2024 03:49 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:HUMMINGBIRDS COLLABORATIVE SCHOOLFACILITY NUMBER:
214005477
ADMINISTRATOR:RICHARD, MELINDAFACILITY TYPE:
850
ADDRESS:1990 NOVATO BLVD.TELEPHONE:
(415) 760-6197
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 35DATE:
01/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:MELINDA RICHARDSTIME COMPLETED:
03:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On January 18, 2024, Licensing Program Analyst (LPA) Garcia met with director, Melinda Richard for an unannounced required inspection for the preschool facility. Purpose of the inspection was explained. There were total of 35 children, and 9 teachers including the director, in the preschool. Facility operates day care program Monday through Friday from 7:30 AM through 5:00 PM.

LPA inspected day care rooms and the outdoor space. LPA observed facility has multiple smoke detectors and carbon monoxide detectors, multiple fully charged fire extinguisher model 3A40BC located on multiple areas. 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. The bathroom is in working condition, LPA checked sinks and toilets. Individual items provided by the parents are labeled and stored appropriately. According to staff, the facility serves morning and afternoon snacks and lunches. Some children has the option to bring their lunches from home. Per Melinda, the children are provided through water services, "Alhambra" dispensers located in each classroom, refilled as needed. All children bring their water bottles from home. All food is stored properly to avoid contamination. Food is stored adequately to prevent contamination and properly labeled in the refrigerators. There is water available for children in the yard as well as in the classrooms and emergency bags/shed.

LPA observed outdoor areas and play structures are free from health and safety hazards. The outdoor area has play structures, wood chips with shaded areas for the children to rest. There are a variety of toys and sport equipment available for the children. There are also sheds/bins and storage areas for the toys when they're not being used. LPA observed there are multiple bicycles/trolleys and sand play an box for children to use.

***page 2 for continuation***

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HUMMINGBIRDS COLLABORATIVE SCHOOL
FACILITY NUMBER: 214005477
VISIT DATE: 01/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***Page 2 continued***

CHILD CARE CENTER NOT COMPLETED THE LEAD WATER TESTING. FACILITY WILL BE REQUESTING FOR AN ATTESTATION.


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.

LPA advised the the director to provide documentation and to request for an attestation for the lead water testing. LPA observed that there are multiple water dispensers inside and outside the facility.

According to Melinda, the facility is using paper for sign in/out. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log and last drill was conducted on October 2, 2023. Per Melinda, drills are done at least every month and the school also rotates them between lock down/fire and earthquake drills.

The LPA reviewed the facility records. LPA reviewed 6 children's files during the visit. LPA reviewed 3 staff files with qualifying requirements such as ECE Units, CPR and Mandated Reporter Training. The facility has a set learning curriculum and schedule posted in the classroom.



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.

***Page 3 for continuation***
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HUMMINGBIRDS COLLABORATIVE SCHOOL
FACILITY NUMBER: 214005477
VISIT DATE: 01/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***Page 3 Continuation***

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.

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.

Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information 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 violation for not requesting for an attestation letter before the January 1, 2023 deadline.

A copy of this report, and the “Notice of Site Visit” were given to the 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 with Melinda Richard.

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

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 01/18/2024 03:49 PM - It Cannot Be Edited


Created By: Nathan Garcia On 01/18/2024 at 03:44 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: HUMMINGBIRDS COLLABORATIVE SCHOOL
FACILITY NUMBER: 214005477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2024
Plan of Correction
1
2
3
4
The facility will send documentation and attestation letter to the LPA by set due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


LIC809 (FAS) - (06/04)
Page: 4 of 4