414004829-8-17-2021-05-CC-MROZ-C5YU6H-20210817151822

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004829
Report Date: 08/17/2021
Date Signed: 08/17/2021 03:19:13 PM

Document Has Been Signed on 08/17/2021 03:19 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:	NOTRE DAME PRESCHOOL		FACILITY NUMBER:	414004829
ADMINISTRATOR:	GIULIANETTI, HAYDET		FACILITY TYPE:	850
ADDRESS:	1200 NOTRE DAME AVENUE		TELEPHONE:	(650) 591-2209
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/17/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Kathleen Jeremiassen, Haydet Giulianetti, and Karen Rende		TIME COMPLETED:	03:30 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	Licensing Program Analyst (LPA) Marie Rodriguez met with Applicants Kathleen Jeremiassen, Haydet Giulianetti, and Karen Rende for a scheduled Pre-Licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is requesting an emergency license for 30 children (ages 3 years to entry into first grade). The facility will operate Monday - Friday; 8:00 AM to 5:30 PM. The designated director/site supervisor for the facility is Haydet Giulianetti. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. Indoor: There is one classroom that will be used for the preschool program and one classroom for the transitional kindergarten (TK) program. Total useable indoor area measures at 1545.91 sq ft divided by 35 sq ft equals 44 children. Applicant is requesting a total capacity of 30 children. The indoor space for children is observed today to be clean and all furnishings, toys, and equipment observed to be safe and in good condition. There is a storage space for children's personal belongings and cots will be utilized for napping children. Parents will provide a sheet and blanket for their child and bedding will be sent home to be laundered weekly. Cots will be cleaned at least weekly or more often if needed. Children will be signed in and out manually. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, a separate kitchen area where snack food is stored, garbage cans with tight-fitting lids, a first aid kit, and emergency supplies. The facility is adequately ventilated and free of insects and bugs. The facility will only provide a morning and afternoon snack. Children will bring their own lunch each day. Snack foods will be stored in the kitchen separately from any cleaning products or other hazards. All toxins and other hazardous items will be stored in the cabinet above the sink and will be inaccessible to children. Medications will be stored in a locked box in the kitchen area inaccessible to the children. During the COVID-19 pandemic and long term plan, children will bring in their own reusable water bottle to use and water refills will be dispensed by staff. Isolation of ill children will be in the director's office and staff bathroom will be used for an ill child. (Continued on next page)

SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

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: NOTRE DAME PRESCHOOL	FACILITY NUMBER: 414004829
	VISIT DATE: 08/17/2021

NARRATIVE

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There are two toilets and three sinks accessible for children's use (one sink in the bathroom, one sink in the preschool classroom, and one sink in the TK classroom.) Bathroom is located between the preschool and TK classrooms. The bathroom will be shared between programs and a schedule will be created for use. The bathroom will be cleaned and disinfected in-between scheduled use of each classroom and between use by each child. The bathroom was observed to be clean and with no health and safety hazards. Sinks accessible to children will only deliver cold water. A separate bathroom is available for staff.

Outdoor: The outdoor area measures a total of 9302.20 sq ft. divided by 75 sq ft allowing for a total of 124 children. The outdoor area to be used is enclosed by at least a four foot fence and is observed to be clean, safe and equipped with toys and equipment for children. Resilient material is located around the play structure and remaining outdoor area has a combination of dirt and fake turf/grass. During the COVID-19 pandemic and long term plan, for outdoor access to drinking water, children will bring in their own reusable water bottle to use and water refills will be dispensed by staff. Shade for children will be provided by portable shade structures.

The following items were reviewed as part of today's visit: Record keeping for staff, children, and facility records, Care and Supervision of the Children, Child Discipline Procedures (staff will talk with the children and use redirection with a book in the quiet area), Emergency Evacuation Procedures, Medication Policies (non-prescription medications will not be administered), Isolation of Sick Children, Napping Requirements, Food Service, Transportation (none will be provided), Parents Rights, and Reporting Requirements. Required postings were observed during today's inspection. Facility will conduct quarterly disaster drills and a log will be maintained for review upon request. The fire inspection was conducted, and approval was received on August 11, 2021. The requirement for Lead Water Testing was discussed (H&S Code 1597.16). PIN 21-21-CCP and PIN 20-01-CCP were provided to applicants during today's inspection.

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SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

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: NOTRE DAME PRESCHOOL	FACILITY NUMBER: 414004829
	VISIT DATE: 08/17/2021

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This facility plans to provide Incidental Medical Services (IMS) and will provide CCLD with a written plan. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA conducted a Pre-Licensing Inspection today and the inspection included providing the applicants with the COVID-19 self-assessment guide. LPA also reviewed COVID-19 required postings and provided additional COVID-19 resources to applicant. Applicant was informed that access to available Personal Protective Equipment (PPE) may be available through the local childcare resource and referral agency.

LPA will approve an emergency provisional license for facility with a capacity of 30 children effective today, August 17, 2021. Provisional License period will be effective from August 17, 2021 through November 15, 2021.

LPA will provide applicants with a separate list of any remaining documents that are needed or any revisions that needed to be made once full review of application has been completed.

Report was reviewed and discussed with Applicant Haydet Giulianetti. A copy of report was provided.

SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC809 (FAS) - (06/04)

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