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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414003031
Report Date: 09/06/2022
Date Signed: 09/06/2022 04:18:11 PM

Document Has Been Signed on 09/06/2022 04:18 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:IHSD, INC-LAKEWOOD CDC (PS)FACILITY NUMBER:
414003031
ADMINISTRATOR:GHEITH, KIFAHFACILITY TYPE:
850
ADDRESS:65 TOWER ROADTELEPHONE:
(650) 578-3440
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 15DATE:
09/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Kifah Gheith TIME COMPLETED:
04:30 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 9/6/2022 at 12:10PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Kifah Gheith. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Present was the director and five staff supervising 15 children. All staff have their criminal record clearances on file. Children present had been properly signed in. Preschool program utilizes two classrooms: Rooms #5 and #7, and two outdoor play yards. Day and hours of operation are Monday- Friday, 8:00AM- 4:00PM. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 12:20PM., LPA observed the following: Classrooms were clean, orderly, with age-appropriate playthings available for the children. Floors and ground surfaces were free of obstructions. Accessible furniture, books and materials inspected were in proper repair. Classrooms were equipped with storage cubbies and several child sized table and chairs. Bathrooms and sinks had adequate supplies for hand washing. Fixtures tested were operating condition. Staff bathroom is located separately. For napping services, cots are stored in each classroom. Per director, napping sheets are washed weekly on-site. Classroom had acceptable ventilation and lighting. Detergents; cleaning supplies; and toxins were stored inaccessible to children. Electrical outlets, heater vents, and trash bin had been covered. Classrooms had functioning smoke/ carbon monoxide detector combo; and two (fully charged) fire extinguishers; 2A:40BC. First aid kit was reviewed during inspection.

At 12:50PM., LPA inspected the outdoor play areas. Areas had been enclosed with tall fencing. Available seating was available with proper shading. Outdoor spaces were observed free of debris or hazardous plants or objects. LPA reminded director to ensure all broken playthings are removed from outdoor area. Play structure is in good repair and anchored. Rubber cushioning had been installed around structure for added safety. Per director, water services are provided to children with use of refillable water containers and paper cups, brought outside by staff. LPA reminded facility to ensure all children water bottles are labeled with child’s name. (REFER TO 809C, FOR CONT.)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
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: IHSD, INC-LAKEWOOD CDC (PS)
FACILITY NUMBER: 414003031
VISIT DATE: 09/06/2022
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
(Page 2)
At 1:25PM, LPA review facility records including nine children’s files and five personnel files. Staff files reviewed and included Notice of Employee Rights (LIC9052); Criminal Record Statement; Proof of Qualifications; and Declaration to Report Suspected Child Abuse (LIC9108);

LPA reminded director to ensure staff’s Mandated Reporter Training Certification (AB1207) are stored in the facility files.

Present staff member CPR/ 1st aid certification was current, expiring on 08/15/2024
Disaster drills are conducted every six months with the last drill done on, 8/23/2022, properly logged.

Children’s files included the: Immunization Record; Identification of Emergency Information (LIC700); Health History; Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

LPA observed required postings including: Childcare License; Outdoor Space Waiver; Child Passenger Safety Laws; Notification of Parent’s Rights (PUB393); Emergency Disaster Plan (LIC610); and Updated Menu. Children’s medication and IMS plan was reviewed during inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm (REFER TO 809C FOR CONT.)
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: IHSD, INC-LAKEWOOD CDC (PS)
FACILITY NUMBER: 414003031
VISIT DATE: 09/06/2022
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
(Page 3)
Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview and report was reviewed with Director, Kifah Gheith and signature of this form acknowledges receipt of these documents.

This report and appeal right and rights were discussed. This report must be available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Any additional questions facility was advised to call Regional Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3