414004701-9-21-2023-05-CC-MOLN-CVVUNK-20230921154404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004701
Report Date: 09/21/2023
Date Signed: 09/21/2023 03:44:10 PM

Document Has Been Signed on 09/21/2023 03:44 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:	AFTERSCHOOL CARE ENRICHMENT-AT MARIPOSA		FACILITY NUMBER:	414004701
ADMINISTRATOR:	AGUILA, ANTHONY		FACILITY TYPE:	840
ADDRESS:	750 DARTMOUTH AVENUE		TELEPHONE:	(650) 226-3480
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY: 95	TOTAL ENROLLED CHILDREN: 100	CENSUS: 83	DATE:	09/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Joseph Pangilinan		TIME COMPLETED:	03:59 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 September 21, 2023, at @ 1:45PM Licensing Program Analyst (LPA) Maria Olguin-Leon met with Director Joseph Pangilinan for an unannounced annual inspection. Purpose of inspection was explained. Director Nick Puccinelli arrived during visit. Present today was both Directors, 8 staff and 83 school age children. Facility is operating within capacity and in compliance with staff child ratio. All staff is fingerprint cleared. Facility operates before & after-school program from Monday to Friday 7:30AM to 9:30 AM and 12:00 PM to 6:00PM. LPA and Director toured the facility for health and safety hazards. Facility operates in three Classrooms on the campus of Mariposa Upper Elementary School site in classroom T, S, and O. Classrooms are clean with proper ventilation. There are plenty of age-appropriate toys/games, books, furniture and learning materials all in good repair. There are plenty of tables with chairs and a pool table. All trash containers have tight fitting lids. School bathrooms are on site and have working toilets and sinks with no hot water. Facility uses school playground which has a large play structure in good repair. Playground flooring has new tanbark for cushioning falls. There is a large blacktop area with basketball courts. No pools or bodies of water were observed. After school program provides breakfast and snacks for children. Food is properly stored and labeled in cabinets and refrigerator to avoid contamination. Children bring their own labeled water bottles and school provides filtered water for children. There is a fully equipped first aid kit located in kitchen cabinet. Incidental Medical Services were discussed, Isolation area for sick children is on couches away from other children. All cleaning products, chemicals, and toxins are inaccessible to children and locked in storage cabinets. LPA reviewed sign in/out sheet. Parents sign children in and out in the morning/afternoon. After school care children are signed in by staff. Classroom is equipped with school integrated smoke/fire alarm system, carbon monoxide detector and fully charged fire extinguishers. Classroom is equipped with a working telephone landline and walkie talkies are used by staff for communication. Cont. on page 2

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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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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: AFTERSCHOOL CARE ENRICHMENT-AT MARIPOSA	FACILITY NUMBER: 414004701
	VISIT DATE: 09/21/2023

NARRATIVE

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LPA reviewed 5 children’s records and 5 staff record. All the records were complete and up to date. The facility has all necessary paperwork posted, Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Last emergency drill was conducted on 09/20/2023. Per Director there are no firearms or weapons on site.

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 reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

The Director was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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.

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. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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: AFTERSCHOOL CARE ENRICHMENT-AT MARIPOSA	FACILITY NUMBER: 414004701
	VISIT DATE: 09/21/2023

NARRATIVE

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LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. LPA collected proof of water lead testing.

LPA reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must 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 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.

As of today, no deficiencies were issued under CCR, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director Nick Puccinelli.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC809 (FAS) - (06/04)

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