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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004571
Report Date: 09/29/2021
Date Signed: 09/29/2021 03:31:39 PM

Document Has Been Signed on 09/29/2021 03:31 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, LLCFACILITY NUMBER:
414004571
ADMINISTRATOR:CHISHOLM, HEATHERFACILITY TYPE:
850
ADDRESS:1400 ALAMEDA DE LAS PULGASTELEPHONE:
(650) 678-8244
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY: 36TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Gina SpauldingTIME COMPLETED:
03:50 PM
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On September 29, 2021 at 11:10 AM, Licensing Program Analyst (LPA) Cowan met with new director, Gina Spaulding, for a 1-Year Required inspection. Licensee Audra Tsivikas joined the inspection. Purpose of the inspection was explained. Present, in the facility are director, 2 staff, and 18 children in care. Facility is operating within the capacity and is in compliance with staff / child ratio on this day. Facility operates day care Monday to Friday from 07:15 AM to 04:15 PM. Facility operates in one room and has two classes: Beetles and Honey Bees. When LPA arrived children were having story time and transitioning to lunch time.

With director, LPA inspected the day care rooms and play yard. LPA observed facility has smoke detector, carbon monoxide detector, and working telephone on site. All cleaning solutions, poisons and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Facility floor is in good repair and free of any hazards.

All bathrooms are in working condition. All storage containers for solid waste fitted lids. All food is stored properly to avoid contamination. Facility has a sufficient amount of sleeping matts available. Water bottles and other items provided by the parents are labeled and stored appropriately. Food preparation area is free of litter. Food is stored adequately to prevent contamination. Play yard is free of hazards. There is a sufficient amount of cushion material in the play yard to help absorb the impact of falls. There is water available on the yard as well as in the classroom.
Report continues on next page……….
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HAPPY CAMPERS AT CARLMONT, LLC
FACILITY NUMBER: 414004571
VISIT DATE: 09/29/2021
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LPA observed that facility is using electronic sign in / out. Facility has license and all other required documents posted and visible for the public. Facility’s last emergency drill was conducted July of 2021 and is properly logged. At 12:35 PM, LPA reviewed the facility records. LPA reviewed 10 random children's files. LPA reviewed 3 staff's files. Files are complete with required Licensing documents.

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.

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

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HAPPY CAMPERS AT CARLMONT, LLC
FACILITY NUMBER: 414004571
VISIT DATE: 09/29/2021
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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/process.

>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3.



This report must be available in the facility for public review. Notice of site visit was observed being posted. 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: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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