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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002154
Report Date: 07/22/2024
Date Signed: 07/22/2024 04:05:44 PM

Document Has Been Signed on 07/22/2024 04:05 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:CITY OF PACIFICA-FAIRMONT WEST PRESCHOOLFACILITY NUMBER:
414002154
ADMINISTRATOR/
DIRECTOR:		ANGELA EUGENIOFACILITY TYPE:
850
ADDRESS:5066 PALMETTO AVENUETELEPHONE:
(650) 738-7463
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 12DATE:
07/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Angela EugenioTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On July 22, 2024 at approximately 2:15 PM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with center director, Angela Eugenio.

Hours of operation are Monday to Friday 7:00 AM to 6:00 PM. Present during inspection included 12 children with 3 staff members (including director). Facility is operating within capacity requirements and ratios at time of LPA's inspection. Facility is a single floor building with one classroom, a children's bathroom, a staff bathroom, an office, and one storage closet.

LPA and director inspected facility, indoors and outdoors, for health and safety hazards. Program operates out of one classroom. LPA observed classrooms to be clean, equipped with age appropriate toys, materials, and furniture. LPA observed electrical outlets to be made inaccessible with outlet covers and furniture. LPA also observed covered trash cans in the classroom. Storage for children's belongings are located inside classroom, labeled with each child's individual names. LPA observed classroom has enough sleeping cots available for all children in care. Per director, facility washes sheets weekly.

LPA observed facility has an installation of a fire alarm system throughout the building. There is a working carbon monoxide located near the kitchen area of the facility. Classroom has multiple fully stocked and accessible first aid kits. Facility has a fire extinguisher located near the kitchen area. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children on facility's high shelves.

LPA observed children's bathrooms to be clean and in proper working condition. Facility provides all food services. Facility provides a morning snack, lunch, and afternoon snack. Water is available to children indoors and outdoors with children's water bottles and/or pitchers. Facility also has closed water bottles available for children in care.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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: CITY OF PACIFICA-FAIRMONT WEST PRESCHOOL
FACILITY NUMBER: 414002154
VISIT DATE: 07/22/2024
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Outdoor area is fully enclosed and has age appropriate toys and materials that were in working condition. LPA observed play structure to contain padding underneath.

Children are signed in and out of facility through a paper system by the front entrance. All children have individual sign in and out binders in individual cubbies. Facility has license documentation and information properly posted and available for review in main entrance of facility. Preschool program conducts drills every month. Last conducted disaster drill was on 06/18/2024.

LPA reviewed 5 children's files and 3 staff files. Children's and staff files were complete with a record of emergency identification information on file. Director has a valid CPR/First Aid certificate that will expire 11/15/2025. All staff also have proof of required immunization that were made available for review. Mandated Reporter Training Certificates are also available in staff files.

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: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CITY OF PACIFICA-FAIRMONT WEST PRESCHOOL
FACILITY NUMBER: 414002154
VISIT DATE: 07/22/2024
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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 completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit will be emailed and must remain posted for 30 days.

Exit interview conducted and report was reviewed with director, Angela Eugenio.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Janet Gil
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
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