410500322-9-5-2024-05-CC-JGIL-D8TUEP-20240905153129

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410500322
Report Date: 09/05/2024
Date Signed: 09/05/2024 03:31:40 PM

Document Has Been Signed on 09/05/2024 03:31 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	HOPE LUTHERAN PRESCHOOL		FACILITY NUMBER:	410500322
ADMINISTRATOR/ DIRECTOR:	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: 27	CENSUS: 8	DATE:	09/05/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:15 PM
MET WITH:	Tracy Siri		TIME VISIT/ INSPECTION COMPLETED:	04:00 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 September 5th, 2024 at approximately 1:15 PM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with director, Tracy Siri, and explained the purpose of the inspection. Hope Lutheran Preschool operates at Hope Lutheran Church from Monday through Thursday. Preschool provides two part-time preschool classes, a morning class from 8:45 AM to 11:45 AM and an afternoon class from 12:30 PM to 3:30 PM. Present during inspection included 8 children with 3 staff members (including director). Facility is operating within capacity requirements and ratios at time of LPA's inspection. Facility has three open classrooms broken up into sections with a multi-purpose area, an arts and crafts area, and a play area. LPA and director inspected facility, indoors and outdoors, for health and safety hazards out of the three connected classrooms. LPA observed classrooms to be clean, equipped with age appropriate toys, materials, and furniture. LPA observed electrical outlets to be made inaccessible with outlet covers. LPA also observed covered trash cans in classrooms. Storage for children's belongings are located inside first classroom. Per director, Preschool program does not provide a designated nap time due to facility running a half day program. Facility has no enrolled children on IMS Plans on date of inspection. LPA observed multiple smoke and carbon monoxide detectors. Detector was tested in classroom #1 and was observed to be working. Preschool has three fully stocked and accessible first aid kits. Per director, one is taken outdoors during children's outdoor play time. Facility has two fire extinguishers within available classrooms. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children on facility's high shelves. LPA observed children's bathrooms to be clean and in proper working condition. Facility only provides snack as a food service. Menus are posted available for authorized representatives to review. Water is available to children indoors with cups and water pitchers. Per director, if a child would like water during outdoor play, teachers will bring children inside classroom for a water cup. Continue on Page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOPE LUTHERAN PRESCHOOL	FACILITY NUMBER: 410500322
	VISIT DATE: 09/05/2024

NARRATIVE

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Outdoor area is fully enclosed. LPA observed a sandbox to have proper covering. LPA observed play structure to contain tanbark and padding underneath.

Children are signed in and out of facility through a paper system by the front entrance. All children were signed in correctly during LPA's visit. Facility has license documentation and information properly posted and available for review in classroom #2's entrance. Preschool program conducts emergency drills at least once every six months. Last conducted disaster drill was on 05/6/2024.

LPA reviewed 5 children's files and 3 staff files. Children's and staff files were complete with a record of emergency identification information on file. All teachers have a valid CPR/First Aid certificate that will expire 8/2025. All staff also have proof of required immunization that were made available for review. Mandated Reporter Training Certificates are also on file for each staff.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care 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 completed certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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.

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/inspection-process.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HOPE LUTHERAN PRESCHOOL	FACILITY NUMBER: 410500322
	VISIT DATE: 09/05/2024

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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/.

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.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

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

Exit interview conducted and report was reviewed with director, Tracy Siri.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC809 (FAS) - (06/04)

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