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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004317
Report Date: 01/13/2023
Date Signed: 01/13/2023 02:09:49 PM

Document Has Been Signed on 01/13/2023 02:09 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:HAPPY CAMPERS AT CARLMONT HIGH SCHOOLFACILITY NUMBER:
414004317
ADMINISTRATOR:SPAULDING, GINAFACILITY TYPE:
830
ADDRESS:1400 ALAMEDA DE LAS PULGASTELEPHONE:
(650) 678-8244
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY: 24TOTAL ENROLLED CHILDREN: 16CENSUS: 15DATE:
01/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gina SpauldingTIME COMPLETED:
02:25 PM
NARRATIVE
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On January 13, 2023 at 9:30 AM, Licensing Program Analyst (LPA) Cowan met with Site Director, Gina Spaulding, for an unannounced annual random inspection. Present today is director, 5 staff, and 15 infants at this time. The center operates Monday - Friday 7:15 AM to 4:45 PM. The center has two classrooms: Infants (Banana Slugs) and Toddlers (Snails). When LPA arrived, infants were playing.

LPA inspected the infant day care area for health and safety hazards today. The center is clean, orderly and in good repair. There are no pools, spas or other similar bodies of water on site. Per director, there are no firearms or weapons on site. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. All furniture and equipment are clean and in good working condition. The center's furniture and equipment are age appropriate. There is a sufficient quantity of cribs, table, chairs, and changing tables to meet the capacity of infants. Parents provide bedding for cribs and mats. Bedding is sent home once a week for cleaning by parents while cribs and mates are wiped down and disinfected daily. Bottles and other items provided by the parents are labeled and stored appropriately. Food and formula are provided by parents. Changing tables are within an arm’s reach of a sink. The center has a working carbon monoxide detector. LPA observed infants were supervised by staff in the classrooms. All solid waste storage containers have secure lids. The outdoor play area designated for the infants and toddlers was clean and in good repair. All toys and equipment are in working condition. Per director, toys are cleaned daily. Areas under slides and other high climbing equipment is adequately cushioned poured rubber.

At 10:03 AM, Staff files were reviewed. Children's files are complete with all required Licensing documents. At 10:41 AM, LPA observed that staff did not have immunizations on file. At 11:04 AM, LPA observe through record review that staff members were not associated to the facility. At 11:21 AM, LPA observed that staff members did not have Health Screenings on file. At 11:28 AM, LPA observed that staff did not have TB clearance on file. At 11:31 AM LPA observed that a staff member did not have Employee Rights on file. The above deficiencies are potential risks to children in care and Type B citations are issued this day. At least one staff member on site has current CPR/First Aid certification. Children's files were reviewed. Children's files have medical assessments and needs and services plans.


Report Continues ...
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2023
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 10
Document Has Been Signed on 01/13/2023 02:09 PM - It Cannot Be Edited


Created By: April Cowan On 01/13/2023 at 12:43 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: HAPPY CAMPERS AT CARLMONT HIGH SCHOOL
FACILITY NUMBER: 414004317

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review), the licensee did not comply with the section cited above in 2 out of 5 staff did not have immunizations on file] which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Director agrees to email LPA immunizations for Montserrat Cardinas and Maria Talavera by the above date.
Type B
Section Cited
CCR
101170(e)(3)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 101170.1(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review), the licensee did not comply with the section cited above in 2 out of 5 people are not associate to the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2023
Plan of Correction
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Director agrees to associate Montserrat Cardinas and Victoria Green by the above date and email LPA transfer request.
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:April Cowan
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023


LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 01/13/2023 02:09 PM - It Cannot Be Edited


Created By: April Cowan On 01/13/2023 at 12:43 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: HAPPY CAMPERS AT CARLMONT HIGH SCHOOL
FACILITY NUMBER: 414004317

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review), the licensee did not comply with the section cited above in 2 out of 5 staff did not have Health screenings on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2023
Plan of Correction
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Director agrees to email LPA LIC Health Screenings for Dolores Galvan and Victoria Green by the above stated date.
Type B
Section Cited
CCR
101216(l)(1)(B)
Personnel Requirements
(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review), the licensee did not comply with the section cited above in jout of 5 staff did not have Employee Rights on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2023
Plan of Correction
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Director agrees to email LIC 9052 Employee Rights for Victoria Green to LPA by the above stated date.
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:April Cowan
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 01/13/2023 02:09 PM - It Cannot Be Edited


Created By: April Cowan On 01/13/2023 at 12:43 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: HAPPY CAMPERS AT CARLMONT HIGH SCHOOL
FACILITY NUMBER: 414004317

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(b)(1)
Teacher Qualifications and Duties
(1) A teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement specified in (c)(1) below; or shall have obtained a Child Development Assistant Permit issued by the California Commission on Teacher Credentialing.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review), the licensee did not comply with the section cited above in 1 out of 5 teachers did not have transpscripts on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2023
Plan of Correction
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Director agree to email transcripts to LPA for Maria Talavera by the above stated date.
Type B
Section Cited
CCR
101217(A)(12)
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review), the licensee did not comply with the section cited above in 2 out of 5 staff did not have TB clearance on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2023
Plan of Correction
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Director agree to email LPA proof of TB clearance for Diana Meza and Victoria Green
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:April Cowan
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023


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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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HAPPY CAMPERS AT CARLMONT HIGH SCHOOL
FACILITY NUMBER: 414004317
VISIT DATE: 01/13/2023
NARRATIVE
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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.

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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 completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new 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/inspection-process.

>See next page for deficiencies

An exit interview conducted and report was reviewed with site director, Gina Spaulding.

This report must be available in the facility for public review. Notice of site visit is to be posted for 30 days. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC809 (FAS) - (06/04)
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