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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004702
Report Date: 10/02/2023
Date Signed: 10/16/2023 12:23:45 PM

Document Has Been Signed on 10/16/2023 12:23 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 ARROYOFACILITY NUMBER:
414004702
ADMINISTRATOR:SAUCEDO, J./DASKALAKIS, E.FACILITY TYPE:
840
ADDRESS:1710 ARROYO AVENUETELEPHONE:
(650) 264-8133
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: DATE:
10/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:TIME COMPLETED:
04:10 PM
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On October 2, 2023, at @ 1:53PM Licensing Program Analyst (LPA) Maria Olguin-Leon met with Director, Kayleigh Puccinelli for an unannounced annual inspection. Purpose of inspection was explained. Present today was Director, 5 staff and 56 school age children. Director Nick Puccinelli arrived during visit. Facility is operating within capacity and in compliance with staff child ratio. Facility operates before & after-school program from Monday to Friday 7:30AM to 9:00AM and 12:00 PM to 6:00PM.

LPA and Director toured the facility for health and safety hazards. Facility operates in two classrooms on the campus of Arroyo Upper Elementary School site in portable 2B and classroom #4. Classroom #4 was unavailable to tour due to a principal/staff meeting. Portable is clean with proper ventilation. There are plenty of age-appropriate toys/games, pool table, couches, tables, and a television all in good repair. There are cubbies available inside classrooms for storing children’s belongings. 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 one large play structure and spider web climber all in good repair. Playground flooring has tanbark for cushioning falls. There is a large blacktop area and grassy area for children to run and play on. 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 the kitchen cabinet, along with IMS medication. Incidental Medical Services were discussed, Isolation area for sick children is on couch 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 smoke alarms, carbon monoxide detector and fully charged fire extinguisher. 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: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 ARROYO
FACILITY NUMBER: 414004702
VISIT DATE: 10/02/2023
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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. Emergency drills are conducted monthly and last fire/earthquake drill was conducted on 09/01/2023. 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).

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


Cont. page 3...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: AFTERSCHOOL CARE ENRICHMENT-AT ARROYO
FACILITY NUMBER: 414004702
VISIT DATE: 10/02/2023
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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 Directors, Kayleigh Puccinelli & Nick Puccinelli.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
LIC809 (FAS) - (06/04)
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