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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410500602
Report Date: 03/03/2023
Date Signed: 03/03/2023 11:37:13 AM

Document Has Been Signed on 03/03/2023 11:37 AM - 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:ST. PAUL'S NURSERY SCHOOLFACILITY NUMBER:
410500602
ADMINISTRATOR:WILLIAMSON, LISAFACILITY TYPE:
850
ADDRESS:405 EL CAMINO REALTELEPHONE:
(650) 344-5409
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 19DATE:
03/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lisa WilliamsonTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Andrea Medlin met with facility representative for this required annual licensing visit. Purpose of visit explained. Days and hours of operation: Monday-Thursday 9:00AM0-2:45PM and Fridays 9:00AM-1:00PM. There are 19 children present during the visit. Facility meets teacher-child ratio today. Physical plant toured, including the classrooms used for the program. Facility operates their program as a staffing-parent-cooperative center. The facility has multiple fully charged fire extinguishers that meet the minimum requirements, smoke detectors, and carbon monoxide detectors in the facility. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. Staff bathrooms are available. No pools, spas, hot tubs, fish ponds, or bodies of water are present. Per director, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available in the classrooms. Classrooms are set up for child care and furniture and equipment for children is present. Facility provides snacks; parents provide the meals for children. First aid supplies are available in the classrooms. Sick children will be separated from the group and wait for pick up. Outdoor play areas inspected for health and safety hazards. Outdoor activity space surfaces are free of hazards. Facility has posted all the required licensing forms. LPA reviewed staff and children's files. In the files that were reviewed, all children had complete files. In the staff files, all had complete files. At least one staff on site has current Pediatric First Aid and CPR certification. Staff have the required staff immunizations: measels (MMR) and pertussis (TDap).

(Continued on next page 809-C)
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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: ST. PAUL'S NURSERY SCHOOL
FACILITY NUMBER: 410500602
VISIT DATE: 03/03/2023
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Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA is 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. Facility informed that effective 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.

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.

This report is reviewed with facility representative and a copy of this report must be made available for public review upon request.

Notice of Site Visit posted and shall remain posted for 30 days.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Andrea Medlin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
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