410509300-9-12-2024-05-CC-JGIL-D92QXH-20240912123334

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410509300
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:33:43 PM

Document Has Been Signed on 09/12/2024 12:33 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:	PACIFICA NURSERY SCHOOL		FACILITY NUMBER:	410509300
ADMINISTRATOR/ DIRECTOR:	GRIFFITHS, CATHERINE		FACILITY TYPE:	850
ADDRESS:	548 CARMEL AVENUE		TELEPHONE:	(650) 355-4465
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY: 35	TOTAL ENROLLED CHILDREN: 35	CENSUS: 16	DATE:	09/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:20 AM
MET WITH:	Catherine Griffiths (Claire)		TIME VISIT/ INSPECTION COMPLETED:	12:40 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 12th, 2024 at approximately 9:20 AM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with director, Catherine Griffiths (Claire), and explained the purpose of the inspection. Pacifica Nursery School operates as a Parent co-op from Monday through Friday. Hours of operations are 8:45 AM to 12:45 PM. Present during inspection included 16 children with 3 staff members (including director) and 4 parents. Facility is operating within capacity requirements and ratios at time of LPA's inspection. All adults working in facility have fingerprint clearance. Facility has one open classrooms broken up into sections with a multi-purpose area, an arts and crafts area, and a play area. Facility has an off limit kitchen area. LPA and director inspected facility, indoors and outdoors, for health and safety hazards out of classroom. LPA observed classroom 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 classroom. Storage for children's belongings are located inside the classroom. Per director, Preschool program does not provide a designated nap time due to facility running a half day program. Facility has one enrolled child with allergies and epi pen medication. Medication is properly stored in an off-limit area. LPA observed a dual smoke and carbon monoxide detector. Detector was tested in classroom and was observed to be working. Preschool has two fully stocked and accessible first aid kits. Facility has two fire extinguishers available within the classroom. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in facility's utility room that is kept locked. LPA observed children's bathrooms to be clean and in proper working condition. Facility does not provide any food service. Parents and children representatives provide all lunches for enrolled children. Water is available to children indoors and outdoors with children's individual water bottles. Facility has a filtered water dispenser in kitchen area. Continue on Page 2...

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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: PACIFICA NURSERY SCHOOL	FACILITY NUMBER: 410509300
	VISIT DATE: 09/12/2024

NARRATIVE

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Outdoor area is fully enclosed. LPA observed a sandbox. LPA observed a play structure and a swing set to contain tanbark underneath. LPA also observed an enclosed garden available for children's use.

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 by the classroom entrance. Preschool program conducts emergency drills at least once every six months. Last conducted disaster drill was on 05/31/2024. Per director, facility plans to have an emergency drill on 9/19/2024 for the new school year.

LPA reviewed 7 children's files and 3 staff files. Children's files were complete with a record of emergency identification information on file. All teachers have a valid CPR/First Aid certificate on file. 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. Parents volunteering at the facility also have fingerprint clearance and immunization records on file.

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: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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: PACIFICA NURSERY SCHOOL	FACILITY NUMBER: 410509300
	VISIT DATE: 09/12/2024

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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 not completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Facility failed to test for lead water before January 1st, 2023. Type B deficiency is being issued on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

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

Exit interview conducted and report was reviewed with director, Catherine Griffiths (Claire).

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/12/2024 12:33 PM - It Cannot Be Edited

Created By: Janet Gil On 09/12/2024 at 11:52 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: PACIFICA NURSERY SCHOOL	FACILITY NUMBER: 410509300
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in testing for lead water before January 1st, 2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/12/2024
	Plan of Correction
1 2 3 4	Director plans to scheduale with state certified lead water tester and have them complete testing for lead at facility as soon as possible.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Garfield Leung

LICENSING EVALUATOR NAME:

Janet Gil

LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC809 (FAS) - (06/04)

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