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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004603
Report Date: 02/03/2025
Date Signed: 02/03/2025 03:29:12 PM

Document Has Been Signed on 02/03/2025 03:29 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:TRINITY LUTHERAN PRESCHOOLFACILITY NUMBER:
414004603
ADMINISTRATOR/
DIRECTOR:		EYVAZOV, JAMFACILITY TYPE:
850
ADDRESS:1248 BALBOA AVENUETELEPHONE:
(650) 580-2349
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 26DATE:
02/03/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Director, Jam EyvazovTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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On February 3, 2025, at approximately 1:00 PM, Licensing Program Analyst (LPA) Melissa Zaragoza conducted an unannounced, annual inspection. LPA met with the director, Jam Eyvazov, and explained the purpose of the visit.

Trinity Lutheran Preschool is a preschool age program. Preschool program is located inside the Trinity Lutheran church campus. Preschool program operates in 2 classrooms, the 5 years old class, “Senior Casa”, and the 3 ½ to 4 years old class, “Junior Casa”.

Hours of operation are Monday through Friday 8:00am to 5:30pm. Present during LPA's visit was the director, 23 preschool age children and 7 teachers. Program is operating within capacity limits and ratio during LPA's visit. All staff presents have fingerprints and background check on file.

LPA inspected facility, indoors and outdoors, for health and safety hazards. Classroom includes a variety of toys and materials that were in good condition. LPA observed classroom to have age-appropriate furniture, equipment, and materials. LPA observed cleaning materials to be stored in high shelves, locked, inaccessible to children in care.

Per director, children nap while they are in preschool. Children sleep in cots. Per director, cots are wiped down daily. Per director, the parents provide the sheets and blankets. Per director, sheets and blankets are taken home weekly for wash. LPA observed classroom to have outlet covers.

The facility is equipped with a fully charged fire extinguisher and first aid kit. LPA observed Carbon monoxide detectors and smoke detectors in the facility. Carbon monoxide detector and smoke detector were tested during visit and was observed to be working. Storage for children's belongings is in the classroom. Children's cubbies are labeled with children's individual name on it. Per director, children have extra clothes in cubbies for emergencies. LPA did not observe any accessible poisons or chemicals in the classrooms.

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: TRINITY LUTHERAN PRESCHOOL
FACILITY NUMBER: 414004603
VISIT DATE: 02/03/2025
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There is boy’s bathroom and a girl’s bathroom in the facility for the children. Bathroom for children was observed to be clean. The boy’s bathroom has 1 toilet, 1 sink, and 1 urinal. The girl’s bathroom has 1 toilet, and 1 sink. The sinks and toilet were in working condition. Bathroom was equipped with appropriate sanitation products. LPA observed bathroom to have trash can bins with a tight fitted lid. LPA observed no cleaning solutions, poisons, and other hazardous materials for to be stored in the bathroom.

Program provides a food service of morning snack, lunch, and afternoon snack. Per director, food is prepared in the kitchen of the church. LPA observed children’s allergies to be posted in the kitchenette area. Per director, kitchenette is off limits to children.

Outdoor area is entirely enclosed and fenced. LPA observed outdoor play area to have installed roof sunshades. LPA observed a play structure to have cushion flooring. Outdoor play area was observed to have one bathroom outside for children. LPA observed bathroom to have 1 sink and 1 toilet. LPA observed outdoor toys and material to be in good condition. Per director, children bring water bottles from home, and refill them in the classroom.

Program uses an app, "Bright Wheel" for parents to sign in and out for their sign in/sign out system. Children were properly signed in during LPAs’ visit. LPA observed licensing posters and required documents to be properly posted inside the facility. Program’s last disaster drill was conducted on January 10, 2025.

LPA reviewed 6 facility staff records. LPA reviewed 6 children facility records which were complete and had all required documents. Children's records have emergency information on file. All staff on site have a current CPR/First Aid certification and mandated reporter certification. Staff records also include required immunizations that were made available for review.

Director was reminded all staff hired are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
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: TRINITY LUTHERAN PRESCHOOL
FACILITY NUMBER: 414004603
VISIT DATE: 02/03/2025
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Director 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.

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.

Water quality was tested on 12/27/2022 and results complied.

LPA's discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed director 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.

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 PIN 22-02-CCP. 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/.

Director 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.

There are no deficiencies cited today.

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

Exit interview conducted and report was reviewed with the director, Jam Eyvazov.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Melissa Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
LIC809 (FAS) - (06/04)
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