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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380500371
Report Date: 09/17/2024
Date Signed: 09/17/2024 01:01:41 PM

Document Has Been Signed on 09/17/2024 01:01 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:LAKESIDE PRESBYTERIAN CHURCH NURSERY SCHOOLFACILITY NUMBER:
380500371
ADMINISTRATOR/
DIRECTOR:		MICHELLE ADELSHEIMFACILITY TYPE:
850
ADDRESS:201 EUCALYPTUS DRIVETELEPHONE:
(415) 564-5044
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94132
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 65DATE:
09/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Michelle AdelsheimTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On September 17, 2023., Licensing Program Analyst (LPA) Van met with Director Michelle Adelsheim for an unannounced annual random inspection. The purpose of the inspection was explained to the Director. This is a preschool program. Sixteen staff supervised 65 preschool children during the visit. The facility complies with the staff-children ratios today. All staff members' criminal record clearances were verified with the CDSS Guardian Background check system, and their status showed eligible clearance. The days and operations hours are Monday - Friday from 7:30 a.m. to 6:00 p.m.

LPA toured and inspected the physical plant to identify any health and safety hazards. The facility utilizes Brightwheel, an electronic sign-in/out app. The Director mentioned that each family receives a unique code to access the app. The facility is in good condition and has appropriate temperature and ventilation. Age-appropriate toys and learning materials are available in all classrooms. The furniture was observed to be sturdy and well-maintained. The facility has a centralized smoke alarm, carbon monoxide detector, fully charged fire extinguishers, and functional telephones. LPA noticed that each child has their cubby labeled with their name.

All emergency supplies are securely stored in a locked area. Medications are kept in the main office, and all medicines are stored in original containers with parental consent. First aid supplies are fully stocked and readily available for children's use. All cleaning solutions, poisons, and other dangerous chemicals are stored in an area inaccessible to children. The sleeping cots are appropriately stored. All children's toilets and handwashing sinks are in good working condition with proper sanitation. There is a separate bathroom for staff use on the premises. LPA observed no bodies of water on the premises.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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: LAKESIDE PRESBYTERIAN CHURCH NURSERY SCHOOL
FACILITY NUMBER: 380500371
VISIT DATE: 09/17/2024
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The facility currently has an outdoor waiver from the Department, allowing a maximum of 60 children in the playground at one time. The outdoor play area is well-maintained, clean, and free of debris. It is fully fenced and in good condition. Additionally, all play structures, including climbing and sliding equipment, have soft artificial turf underneath to prevent accidental falls. Per the director, the sandbox is inspected daily before children use it.

The center provides only morning and afternoon snacks, children bring their lunch from home. The director mentioned that on Tuesdays and Fridays, the center offers pizza delivered from a third-party vendor for children who choose to participate in the lunch program. The facility has a water filtration refill station for children indoors and outdoors.

All required postings, such as the facility License, Notification of Parent Rights, Personal Rights, Car Seat Law, Emergency Disaster Plan, and Daily activities, were posted. All storage containers for solid waste within the Center have a proper tight-fitting cover.

Random children's records and personnel records were reviewed during the inspection. Records review showed the facility has complete records of each child, including immunizations, admission agreements, emergency contact, and personal rights. Staff records indicate that all staff or other individuals who require caregiver background checks have received criminal records and child abuse index clearances or exemptions. All staff members have a record of valid CPR and maintain proper immunization records. The director's and staff's educational qualifications showed they had the required ECE units. The Director stated that the Center conducts fire and earthquake drills monthly; the last drills were conducted on 9/24/2024.

The Director 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.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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: LAKESIDE PRESBYTERIAN CHURCH NURSERY SCHOOL
FACILITY NUMBER: 380500371
VISIT DATE: 09/17/2024
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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.

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:

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

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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/.

The Director 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.

LPA discussed Child Abuse Mandated Training AB1207 with the Director. As of January 1, 2018 all staff will be required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Pesticide regulations were discussed with the Site Director. In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Pesticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. For questions, email ccipmlist@cdpr.ca.gov.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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: LAKESIDE PRESBYTERIAN CHURCH NURSERY SCHOOL
FACILITY NUMBER: 380500371
VISIT DATE: 09/17/2024
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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.

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

An exit interview conducted, and report was reviewed with the Director, Michelle Adelsheim.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC809 (FAS) - (06/04)
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