410518747-10-17-2025-05-CC-CQUO-DMJRR3-20251017131428

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410518747
Report Date: 10/17/2025
Date Signed: 10/17/2025 01:14:41 PM

Document Has Been Signed on 10/17/2025 01:14 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:	RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL		FACILITY NUMBER:	410518747
ADMINISTRATOR/ DIRECTOR:	PENA, ROXANA		FACILITY TYPE:	850
ADDRESS:	701 CHARTER ST, PORT 1,2,3,& 4		TELEPHONE:	(650) 482-2407
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94063
CAPACITY: 105	TOTAL ENROLLED CHILDREN: 80	CENSUS: 48	DATE:	10/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Roxana Pena		TIME VISIT/ INSPECTION COMPLETED:	01:30 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 October 17, 2025 at approximately 8:45am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. LPA met with site supervisor, Roxana Pena, and explained the purpose of the visit. Preschool program is Hoover CDC and operates on the Hoover Elementary School site in portable classrooms #1, 2, 3 and 4. Hours of operation for preschool program are Monday through Friday 8:00am to 4:00pm. Classroom #1 included 13 children with 3 teaching staff. Classroom #2 included 12 children with 2 teaching staff. Classroom #3 included 12 children with 3 teaching staff. Classroom #4 included 11 children with 3 teaching staff (including site supervisor). Present during LPA's visit included a total of 11 teaching staff (including site supervisor) and 48 preschool children. Preschool program is operating within capacity limits and ratio during LPA's visit. All teaching staff are fingerprinted through Redwood City School District. With site supervisor, LPA inspected classrooms and outdoor area for health and safety hazards. LPA observed classrooms to be clean. There are carpets and rugs in the classrooms that are clean. Per site supervisor, carpets are vacuumed daily by janitorial services. LPA observed each classroom to be equipped with a variety of children's toys and materials that are in good condition. Classrooms include activities for dramatic play, writing, manipulative play, and arts and crafts. Each classroom is equipped with its own set of children's restrooms, food preparation areas (equipped with sink and microwave) and teacher's spaces. Storage for children's belongings are located inside each classroom, labeled with children's names or pictures of the individual child. Children sleep on cots that are stored appropriately when not in use. Sheets and blankets are provided by children's families and stored in children's individual cubbies or containers so that they are not touching each other. Per site supervisor, cots are sanitized daily while sheets are sent home weekly for laundering. (Continue Report on Page 2...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL	FACILITY NUMBER: 410518747
	VISIT DATE: 10/17/2025

NARRATIVE

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LPA observed electrical outlets in classrooms to be made inaccessible with child safety covers. In classroom #1, LPA observed a drawer in food preparation area that did not have a child safety lock installed. LPA observed drawer to have knives stored. A type B citation was issued. LPA advised site supervisor to either install a child safety lock on drawer where knives are stored or to place knives in a high shelf, inaccessible to children. Site supervisor removed knives from drawer and placed them in a high shelf, inaccessible to children. Deficiency was cleared during visit.

Each classroom is equipped with a first aid kit, fire extinguisher, smoke alarm, emergency backpacks and smoke detectors. LPA tested multiple carbon monoxide detectors during today's visit, which were observed to be in working condition.

LPA observed chemicals and solutions in classrooms to be stored behind child safety locked cabinets. In classroom #3, LPA observed poisons stored in a cabinet. LPA observed a child safety lock hanging on the handle of the cabinet, however, safety lock was not in place or locked. LPA observed cabinet with cleaning solutions and poisons to be accessible. A type B citation was issued. LPA reminded site supervisor cabinets and storage with poisons must be locked at all times. Site supervisor locked cabinet with poisons and informed teaching staff in classroom. Deficiency was cleared during visit.

There are two outdoor areas that are shared between the preschool programs. LPA observed outdoor areas to be separate from one another and to be fully fenced and enclosed. There are a variety of outdoor toys and equipment that are in good condition. There is sufficient shade in the outdoor areas, when needed. LPA observed climbing structures in outdoor areas with resilient padding underneath. There are storage sheds in the outdoor area that were observed to be locked. LPA did not observe any bodies of water on site.

Drinking water is available both in doors and outdoors with children's individual water bottles that can be refilled on site through purchased water jugs or filtered water pitchers (filled through classrooms' sinks).

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.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
(Continue Report on Page 3...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

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: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL	FACILITY NUMBER: 410518747
	VISIT DATE: 10/17/2025

NARRATIVE

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Restrooms for children's use were observed to be in working condition. Restrooms include appropriate sanitation and toileting equipment for children's use. There are enrolled children who are currently in diapers Preschool program provides diapers and wipes to diapering children. Per director, diapering procedures include changing paper that is changed after each child's use. LPA observed garbage bins in children's restrooms and classrooms to have tight fitting lids.

Food service is provided through school district that includes breakfast, lunch and snack. Food is prepared in elementary school's cafeteria and distributed to each classroom. Teaching staff conduct additional food preparation in each classroom, including cutting fruit. Disposable utensils and materials are utilized for children and are stored appropriately.

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

Children are signed into and out of program with authorized representatives' written signatures. Sign in and out sheets are maintained in each classroom. LPA observed sign in and out sheets to be maintained for the month, include a child's individual name, the time the child is signed into and out of program and the written signature of the individual signing the child in and out.

LPA reviewed 7 random children's records. Children's records are complete with emergency contact information. LPA also reviewed 5 teaching staffs' records. Teaching records are also complete with educational transcripts/permits and required immunizations. Teaching staff also have Mandated Reporter certificates available for review. Multiple staff on site have a current CPR and First Aid certification.

Emergency disaster drills are conducted monthly and are documented. Last documented disaster drill was conducted October 16, 2025.

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
(Continue Report on Page 4...)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

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: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL	FACILITY NUMBER: 410518747
	VISIT DATE: 10/17/2025

NARRATIVE

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At approximately 12:40pm, Child Development Program Director, Jennifer Pare, arrived to facility.

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.

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.

During today's visit, facility was issued a Type B citation for accessible knives in a classroom. Site supervisor removed knives from an accessible drawer to a high classroom shelf, inaccessible to children. Deficiency was cleared during visit.

Facility was also issued a Type B citation for accessible poisons and cleaning solutions in a classroom. Site supervisor locked the cabinet that poisons and cleaning solutions were stored in. Site supervisor also informed teaching staff storage for poisons and cleaning solutions must always be locked. Deficiency was cleared during visit.

Appeal rights were provided to facility representative.

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

Exit interview conducted and report was reviewed with site supervisor, Roxana Pena.

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/17/2025 01:14 PM - It Cannot Be Edited

Created By: Catrina Quimbo On 10/17/2025 at 12:03 PM

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: RCSD CHILD DEV SERVICES-HOOVER STATE PRESCHOOL	FACILITY NUMBER: 410518747
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above. In classroom #1, LPA observed knives stored in a drawer without a child safety lock, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/17/2025
	Plan of Correction
1 2 3 4	LPA advised site supervisor to either install a child safety lock on the drawer where knives are stored or to place knives in a high shelf, inaccessible to children. Site supervisor removed knives from drawer and placed them in a high shelf, inaccessible to children. Deficiency cleared during visit.

Type B

Section Cited

CCR

101238(g)(1)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. (1) Storage areas for poisons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above. In classroom #3, LPA observed poisons stored in a classroom cabinet without the safety lock in place or locked, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/17/2025
	Plan of Correction
1 2 3 4	LPA reminded site supervisor cabinets and storage with poisons must be locked at all times. Site supervisor locked cabinet with poisons and informed teaching staff in classroom that storage for poisons must be locked. Deficiency cleared during visit.

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

	Marie Rodriguez
NAME OF LICENSING PROGRAM MANAGER:

	Catrina Quimbo
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC809 (FAS) - (06/04)

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