410500322-4-19-2023-05-CC-MROZ-CR2U2G-20230419151155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500322
Report Date: 04/19/2023
Date Signed: 04/19/2023 03:12:02 PM

Document Has Been Signed on 04/19/2023 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:	HOPE LUTHERAN PRESCHOOL		FACILITY NUMBER:	410500322
ADMINISTRATOR:	TRACY SIRI		FACILITY TYPE:	850
ADDRESS:	600 WEST 42ND AVENUE		TELEPHONE:	(650) 345-8438
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY: 27	TOTAL ENROLLED CHILDREN: 22	CENSUS: 7	DATE:	04/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Tracy Siri		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced annual inspection. LPA met with Director Tracy Siri and explained purpose of inspection. Present at the school were the Director, a teacher, and seven preschool aged children. School is operating within capacity requirements and in compliance with child to staff ratio. School operates at Hope Lutheran Church from Monday to Thursday and provides two part-time preschool classes, a morning class from 8:45am to 11:45am and an afternoon class from 12:30pm to 3:30pm. LPA toured school with Director. Facility has three open classrooms broken up into sections with a multi-purpose area, an arts and crafts area, and a play area. Classrooms are in good condition with proper temperature and ventilation and are free of any hazards. Furniture in each classroom are in good repair. Each classroom has age appropriate toys and equipment. There is a girls bathroom with two toilets and one sink. Boys bathroom has one toilet, one urinal, and one sink. Bathrooms appear to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage on the premises. The outdoor play area is fenced for supervision with age appropriate toys and equipment in good condition. Play structures are in good condition with sufficient cushioning underneath. All required postings are posted on the bulletin board next to the classroom door. School only provides morning and afternoon snacks. A snack menu is posted for the month. Food preparation area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. Drinking water is available for children indoor and outdoors. All storage containers for solid waste have a proper lid. All cleaning products, chemicals, and toxins are inaccessible to children. There are no bodies of water, firearms, or weapons on the premises. Last emergency drill was conducted on January 12, 2023. Emergency drills are conducted at least once every six months and are properly logged. School has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system, a fully charged fire extinguisher, a smoke and carbon monoxide detector, and a working telephone available on site.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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: HOPE LUTHERAN PRESCHOOL	FACILITY NUMBER: 410500322
	VISIT DATE: 04/19/2023

NARRATIVE

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Seven children records were reviewed and complete. All children have a record of emergency identification information on file. Two staff records were reviewed and complete. All staff have a criminal record clearance on file. Staff have a current pediatric first aid/CPR certificate which expires in August 2023.

Director was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (US DOJ) 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.

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.

LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Facility Representative Tracy Siri.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC809 (FAS) - (06/04)

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