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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500240
Report Date: 06/16/2022
Date Signed: 06/16/2022 01:21:40 PM

Document Has Been Signed on 06/16/2022 01:21 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:FIRST PRESBYTERIAN CHURCH PRESCHOOLFACILITY NUMBER:
410500240
ADMINISTRATOR:CORPUZ, ANGELINA VFACILITY TYPE:
850
ADDRESS:1500 EASTON DRIVETELEPHONE:
(650) 342-8326
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 18DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Corpuz, AngelinaTIME COMPLETED:
12:45 PM
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****This is an amended report to correct the inspection date.****

On June 16, 2022, Licensing Program Analyst (LPA) Van met with Director Angelina (Julie) Corpuz for an unannounced annual random inspection. The purpose of the inspection was explained and granted entry to the facility by the Director. The Center operates from classrooms number 101, 102, 103, and 104, a play yard on the ground floor, and Classrooms number 202, 203, and 204 on the second floor. Present today are 18 children supervised by 5 staff. The facility complies with the staff-children ratios today. The days and operations hours are Monday - Friday from 7:45 am to 3:00 pm.
LPA toured and inspected the physical plant for any health and safety hazards. The facility utilizes a Bright-wheel app for sign-in /out for parents or authorized representatives; sign-in/out codes are provided to the parents. The facility is in good repair and has proper temperature and ventilation. Classrooms have age-appropriate toys and learning materials. Furniture appears steady and in good repair. The facility has multiple carbon monoxide detectors, a centralized smoke alarm, fully charged fire extinguishers, and working telephones. LPA observed that each child has their cubbies available with their name labeled. All emergency supplies are stored in locked storage. Medications are appropriately labeled and stored out of reach of children. First aid supplies are fully stocked and available for children's usage. All cleaning solutions, poisons, and other dangerous chemicals are stored in an area inaccessible to children. Sleeping cots are appropriately stored.
All toilets and handwashing sinks are in good working condition with proper sanitation. LPA observed no bodies of water on the premises. The outdoor play area is completely fenced, clean, and in good repair. Outdoor play structures are age-appropriate, in good condition, and free of loose parts. Climbing structures are securely anchored, and soft cushioning is underneath all play structures to absorb accidental falls.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FIRST PRESBYTERIAN CHURCH PRESCHOOL
FACILITY NUMBER: 410500240
VISIT DATE: 06/16/2022
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At 9:41 am, LPA observed a child alone, unsupervised by the teacher in that bathroom. However, the teacher was in the same room and in close proximity. LPA reminded the teacher and Director that children should always be supervised at all times and should be escorted to the bathroom. A technical violation was issued today. Director stated the facility will have all staff training regarding supervision and will submit training materials, agenda, and staff in attendance to the Licensing office.
The facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, Emergency Disaster Plan, and Daily activities). Per the Director, the Center provides children with two snacks and lunch. The menu is observed posted. The food preparation area is adequately equipped, clean, and free of hazards; this area is made inaccessible to children. The facility has water pitchers readily available for children indoors and outdoors. All storage containers for solid waste within the Center have a proper tight-fitting cover.
Ten random children's records and personnel records were reviewed during the inspection. Records review showed the facility has records of each child's authorized representative's names, addresses, and telephone numbers. In addition, each child's immunization record, medical assessment, and admission agreement can be located in each child's file. Staff records indicate that all staff or individuals requiring caregiver background checks have received criminal records and child abuse index clearances or exemptions. Multiple staff members have a record of valid CPR. All staff maintained immunization records. LPA reviewed the educational qualification of the staff, and all staff had the required ECE units. The Director stated that the Center conducts fire and earthquakes monthly; the last drill was conducted on May 23, 2022.
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 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
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: FIRST PRESBYTERIAN CHURCH PRESCHOOL
FACILITY NUMBER: 410500240
VISIT DATE: 06/16/2022
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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.
The Director was informed about Mandated Reporter training. In addition to AB1207 training required to complete every two years by the Licensee and all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
LPA encouraged the Director to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Director can also email at childcareadvocatesprogram@dss.ca.gov and ask for the updates to be added to the email list.
During the inspection, LPA requested the following document be sent to the Licensing office by June 30.
1. an up-to-date Emergency Disaster Plan (LIC 610)
2. Personnel Report (LIC 500)
3. Designation of Administrative Responsibility (LIC 308).
4. Incidental Medical Services Plan
5. Updated Mandated reporter training for three teachers
6. Basic Pest Management Training completion for all staff

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Director, Angelina (Julie) Corpuz. Today's report, June 16, 2022, and notice of site visit will be sent to the Director by email by the close of business on June 16, 2022. Confirmation of receipt is required. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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