<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410518055
Report Date: 05/18/2022
Date Signed: 05/18/2022 12:39:03 PM

Document Has Been Signed on 05/18/2022 12:39 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:J.S.D. STATE PRESCHOOLFACILITY NUMBER:
410518055
ADMINISTRATOR:ZIMIGA, LISAFACILITY TYPE:
850
ADDRESS:631 HANOVER ST., RM. 1 & 2TELEPHONE:
(650) 991-1258
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY: 104TOTAL ENROLLED CHILDREN: 104CENSUS: 60DATE:
05/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lisa ZimigaTIME COMPLETED:
01:05 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 May 18, 2022, Licensing Program Analyst (LPA) Kaur met with Administrator Lisa Zimiga for an unannounced annual random inspection. The purpose of the inspection was explained and granted entry to the facility by the Administrator. Present today are 59 children supervised by 11 teachers. The facility complies with the staff-children ratios today. The Center operates in 4 classrooms: classrooms 1,2,5 and 6. The days and operations hours are Monday - Friday from 8:30 am to 12:30pm.
LPA toured and inspected the physical plant for any health and safety hazards. Each classroom has two to three teachers supervising 11 to 14 children. The facility has sign-in /out for parents or authorized representatives in each classroom. The facility is in good repair has proper temperature and ventilation. Classrooms have age-appropriate toys and learning materials. Furniture appears steady and in good repair. The facility has multiple carbon monoxide detectors, a centralized smoke alarm, fully charged fire extinguishers, and working telephones. LPA observed that each child has their cubbies available with their name labeled. All emergency supplies are stored in locked storage. Medications are appropriately labeled and stored in office. First aid supplies are fully stocked and available for children's usage. All cleaning solutions, poisons, and other dangerous chemicals are stored in an area inaccessible to children. Sleeping cots are appropriately stored.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: J.S.D. STATE PRESCHOOL
FACILITY NUMBER: 410518055
VISIT DATE: 05/18/2022
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
26
27
28
29
30
31
32
The Center has 4 toilets and many sinks for children, and the staff has a separate bathroom. All toilets and handwashing sinks are in good working condition with proper sanitation. LPA observed no bodies of water on the premises. The outdoor play area is completely fenced, clean, and in good repair. Outdoor play structures are age-appropriate, in good condition, and free of loose parts. Climbing structures are securely anchored, and there is soft cushioning underneath all play structures to absorb accidental falls. Director stated the sandbox is inspected daily prior to children's play.
The facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, Notification of Personal Rights, Emergency Disaster Plan, and Daily activities). Per the Director, the Center provides snacks, breakfast, and lunch for children. The menu is observed posted.
18 random children's records and personnel records were reviewed during the inspection. Records review showed the facility has records of each child's authorized representative's names, addresses, and telephone numbers. In addition, each child's immunization record, medical assessment, and admission agreement can be located in each child's file. Facility operates with district. Staff files were not at the facility. Multiple staff members have a record of valid CPR. The Director stated that the Center conducts fire and earthquakes monthly, and the last drill was conducted on March, 2022. The isolation area for an ill child is in the Director's office, and the staff will monitor and supervise the child while parents are contacted to come and pick up.
The 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
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: J.S.D. STATE PRESCHOOL
FACILITY NUMBER: 410518055
VISIT DATE: 05/18/2022
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
26
27
28
29
30
31
32
 Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to complete every two years by the Licensee and all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
LPA encouraged the Director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Director can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
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.
No deficiencies are cited today. An exit interview was conducted, and the report was reviewed with the Director, Lisa zimiga. Today's report, May 18, 2022, and notice of site visit will be sent to the Director by email by the close of business on May 18, 2022. Confirmation of receipt is required. LPA informed the Director that the site visit notice must be posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3