414004571-10-19-2023-05-CC-LTMO-CWRQNZ-20231019122000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004571
Report Date: 10/19/2023
Date Signed: 10/19/2023 12:20:12 PM

Document Has Been Signed on 10/19/2023 12:20 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:	HAPPY CAMPERS AT CARLMONT, LLC		FACILITY NUMBER:	414004571
ADMINISTRATOR:	SPAULDING, GINA		FACILITY TYPE:	850
ADDRESS:	1400 ALAMEDA DE LAS PULGAS		TELEPHONE:	(650) 678-8244
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 36	CENSUS: 22	DATE:	10/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Director, Gina Spaulding		TIME COMPLETED:	12:35 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 19th, 2023 at approximately 9AM, Licensing Program Analysts (LPA) Leslit Tapia-Mandujano conducted an unannounced, annual inspection. LPA met with Director, Gina Spaulding and explained the purpose of the inspection. Present in the facility are Director and three staff caring for a total of 22 preschool age children. All adults working in the facility are fingerprint cleared and associated to the facility. Facility is currently operating within teacher to child ratio on this date. Facility is located on Carlmont High School campus and has a combination infant license (G1). Preschool classroom is located on G2. The hours of operation are Monday - Friday from 7:30 AM to 5:15 PM. LPA toured and inspected the child care area indoors and outdoors for Health and Safety Hazards. LPA observed classroom to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located inside the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system inside each classroom as well as a fully charged, fire extinguishers. The classrooms have a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information. Medication is stored appropriately, inaccessible to enrolled children and maintained with proper documentation in the office/kitchen area. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility high shelves. Facility offers hot lunch as an option, and parents bring in snacks and/or lunch for their child. Water is available to children indoors and outdoors. Facility was tested for lead on July 25th, 2023, and there was no exceedance of lead. Facility used sink C to refill a Brita pitcher to refill children's water bottles, and/or prep food as needed. Continued on Page 2..

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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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Document Has Been Signed on 10/19/2023 12:20 PM - It Cannot Be Edited

Created By: Leslit Tapia-Mandujano On 10/19/2023 at 11:41 AM

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, LLC	FACILITY NUMBER: 414004571
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the Lead testing was not done until July 2023 after the required due date which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2023
	Plan of Correction
1 2 3 4	Director emailed proof of lead testing. Facility tested for lead on July 25th, 2023 and results did not have an exceedance of lead.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Leslit Tapia-Mandujano

LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: HAPPY CAMPERS AT CARLMONT, LLC	FACILITY NUMBER: 414004571
	VISIT DATE: 10/19/2023

NARRATIVE

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Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Children are signed in and out of facility with parents' signatures electronically. Facility has license documentation and information properly posted and available for review in the entrance. Per Director, the High School Campus has a pool on site that is passed the football field on the other side of where the Preschool Class is located.

LPAs reviewed facility records that included 5 children's records and 4 staff records. LPAs observed children's records to be complete. At least one staff have an up to date CPR & First Aid certificate. Staff have up to date Mandated Reporter Certificate. Last emergency drill was conducted 07/2023. Emergency drills are conducted at least once every six months and are properly logged and documented.

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 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 completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: HAPPY CAMPERS AT CARLMONT, LLC	FACILITY NUMBER: 414004571
	VISIT DATE: 10/19/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan of Operation that includes IMS must be submitted to the Department. Director will submit an IMS plan to 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.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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.

Based on today's inspection, deficiencies were observed, according to California Title 22, Health and Safety Code of Regulations.

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

Exit interview conducted and report was reviewed with Director, Gina Spaulding.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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