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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004787
Report Date: 05/04/2022
Date Signed: 05/04/2022 01:23:21 PM

Document Has Been Signed on 05/04/2022 01:23 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:UMC PRESCHOOL-BURLINGAMEFACILITY NUMBER:
414004787
ADMINISTRATOR:ARLETTE E. & VIKKI G.FACILITY TYPE:
850
ADDRESS:1443 HOWARD AVENUETELEPHONE:
(650) 347-6432
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 34DATE:
05/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Arlette Erdozaincy & Victoria GomezTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Van met with both Directors Arlette Erdozaincy and Victoria Gomez on May 4, /2022. The inspection's purpose was disclosed, and it was an unannounced mandatory 1-year inspection. This is a Preschool license with a toddler component attached. Both Directors were there, as were five staff members and seven co-op parents responsible for supervising 34 children. Every member of staff has a criminal record clearance on file. There are five classrooms, Room 1 (Toddler), Room 2 (Pre-Kindergarten/mixed age 2.5-5 years), Room 2A (Pre-Kindergarten/mixed age 2.5-5 years), and Room 3 (3 and 4-year-old), Room 3A (3 and 4-year-old). The days and hours of operation are Monday through Friday, 8:45 am to 2:00 pm.

LPA toured and inspected inside and outside the facility alongside Director Arlette Erdozaincy to identify any potential health and safety hazards. There is an electronic signing in and out, and the facility utilizes an app called Jovial. Per Director, parents/authorized representatives are given a Pin to access the app. The facility has proper temperature, with adequate ventilation and lighting. The facility has a working phone, a smoke alarm, a carbon monoxide detector, and a fully charged fire extinguisher in each classroom. The classrooms are clean and organized, with age-appropriate literature and learning resources for the children. There are no obstacles or hazards on the facility floor or ground surfaces. The furniture and toys are in great condition. Individual cubbies for children's belongings are provided and labeled with the child's name. Each classroom has its own set of child-sized tables and chairs. All bathroom fixtures are in good working order and have adequate supplies on site. There are four toilets and eight sinks. All toilets and handwashing sinks are in good working condition with proper sanitation. There is a separate staff bathroom. Cleaning supplies, disinfectants, and other chemicals are completely inaccessible to children. All electrical outlets have childproofed covered. All solid waste storage containers within the Center have an appropriate tight-fitting cover.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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: UMC PRESCHOOL-BURLINGAME
FACILITY NUMBER: 414004787
VISIT DATE: 05/04/2022
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Due to the COVID 19 pandemic, the facility currently does not provides food to the children. Children's snacks and lunch are brought from home.

All emergency supplies are kept in a secure location. Medications are appropriately labeled and kept out of the reach of children. First aid products are fully stocked and ready for use by children. During the medication review, LPA observed one of the children's medications was expired. LPA reminded the Director to check all children's medications for expiration frequently. Technical Violation was issued.

The outdoor area is surrounded by high fencing and is clear of debris. The outdoor play structures and toys are observed in good shape. The outdoor has a shaded area for children. All play structures have wooden barks beneath them to absorb any accidental falls. Drinking water is available for children indoors and outdoors.

Randomly selected children's and personnel records are reviewed. The facility maintained a complete children's file, including all documents required, such as Health History (LIC702), Identification of Emergency Information (LIC700), Consent for Medical Treatment (LIC627), Notification of Parent's Rights (LIC995), and Immunization Records. All personnel or persons requiring caregiver background checks have gotten criminal records and child abuse index clearances or exemptions. Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), Educational Credentials, Notice of Employee Rights (LIC9052), valid Mandated Reporter Training Certification, and Proof of Immunization are all on file for staff. Several members of staff have current CPR certification.

According to the Director, the Center conducts fire and earthquake drills at least every six months, and each classroom/teacher conducts its own drill, with the most recent one taking place on Oct 21, 2021. LPA reminded the Director to create reminders to inform them when the subsequent fire and earthquake to be conducted. Technical Violation was issued for not meeting the required fire and earthquake drills every six months. The isolation location for an unwell child is located in the multi-purpose room, and personnel will observe and supervise the child until parents are notified to come and pick up the child.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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: UMC PRESCHOOL-BURLINGAME
FACILITY NUMBER: 414004787
VISIT DATE: 05/04/2022
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This facility provides Incidental Medical Services – IMS. LPA reviewed the 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The 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.

The Director was advised that a one-time General Training is also needed in addition to the AB1207 training that the License holder and any personnel employed are expected to undergo every two years. Training is available online at www.mandaterreporterca.com. In addition, the Director was reminded about pesticide training. On the DPR website, go to www.cdpr.ca.gov/shoolipm/childcare for further information.

LPA encouraged the Director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Director can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

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.

Today, no deficiencies have been issued. An exit interview took place, and the report was discussed with the Director, Arlette Erdozaincy. Today's report and notice of site visit will be emailed to the Director by the end of business on May 4, 2022. Receipt confirmation is necessary. LPA instructed the Director that the site visit notice had to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC809 (FAS) - (06/04)
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