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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500408
Report Date: 12/12/2024
Date Signed: 12/12/2024 04:01:30 PM

Document Has Been Signed on 12/12/2024 04:01 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:KIRK HOUSE PRESCHOOLFACILITY NUMBER:
410500408
ADMINISTRATOR/
DIRECTOR:		ESTEVERENA,RUTHFACILITY TYPE:
850
ADDRESS:1148 JOHNSON STREETTELEPHONE:
(650) 323-8667
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 44TOTAL ENROLLED CHILDREN: 32CENSUS: 0DATE:
12/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Director, Ruth EsteverenaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 12/12/2024, at approximately 1:30PM, Licensing Program Analysts (LPAs) Jonathan Tse and Jaclyn Naves conducted an unannounced annual visit at the facility. LPAs met with Director, Ruth Esteverena (D1) and explained the purpose of the visit. Present during the visit was D1 and one staff member. There were no children in care during the visit. This facility is a half-day program, operating from 9:00AM to 1:00PM, Monday to Friday.

LPAs and D1 inspected the facility for any health or safety hazards. The facility is equipped with an operational carbon monoxide detector. There are fully charged 2A10BC fire extinguishers present in the facility. Electrical outlets are covered or blocked to be inaccessible. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. LPAs observed first aid kits to contain bandages, gauze, tweezers, and scissors.

LPAs observed there to be age-appropriate toys and learning materials present in the facility. Children have access to blocks, art activities, and manipulatives. Children bring snacks and lunch from home. The facility prepares children’s lunches in the facility kitchen. Off-limits areas are kept inaccessible with locks. The facility uses non-slip rugs. LPAs observed waste bins to be fitted with tight-fitting lids. LPAs observed all toilets and handwashing sinks to be operational during the visit. Drinking water is provided from non-contaminating fixtures and is accessible for children as needed. Children’s medication is stored where accessible to staff and inaccessible to children in care. LPAs verified expiration dates of medication with D1 during the visit.

LPAs observed the outdoor play are to be free of debris and other loose articles. The outdoor play area is enclosed by a fence that is at least four feet high. There are sandboxes present that are checked daily before children go outside. There are age-appropriate play structures and swings that are cushioned by sand and woodchips. There are age-appropriate toys and equipment available for children to use. There are no swimming pools or other similar bodies of water present. There are no firearms or weapons stored in the facility.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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: KIRK HOUSE PRESCHOOL
FACILITY NUMBER: 410500408
VISIT DATE: 12/12/2024
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LPAs reviewed five staff files, six children’s files, and facility records. There is at least one staff member with current Pediatric First Aid/CPR training. All staff members have current Mandated Reporter Training completed. Staff qualifications and immunization records are available for review. All children’s files were observed to be complete. Children are signed in with paper sign-in/out sheets upon entry to the facility. LPAs observed required postings to be posted and accessible for review upon entry to the facility. The facility last conducted an emergency drill on 10/2/2024. Emergency drills are logged and available for review.

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.

Facility representative 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.

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.



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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: KIRK HOUSE PRESCHOOL
FACILITY NUMBER: 410500408
VISIT DATE: 12/12/2024
NARRATIVE
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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 PIN 22-02-CCP. 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/.

Facility representative 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.

No deficiencies were cited during today’s visit on 12/12/2024. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Ruth Esteverena.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC809 (FAS) - (06/04)
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