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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004898
Report Date: 08/09/2022
Date Signed: 08/09/2022 02:47:39 PM

Document Has Been Signed on 08/09/2022 02:47 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:ANNE CAMPBELL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
414004898
ADMINISTRATOR:CHAN, SHERYLFACILITY TYPE:
850
ADDRESS:65 TOWER ROADTELEPHONE:
(650) 802-5616
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
08/09/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sheryl ChanTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted a scheduled Pre-Licensing inspection and met with Applicant Sheryl Chan. Applicant is requesting a capacity of 40 preschool aged children (ages 2 years old to entry into first grade). The facility will operate from Monday to Friday from 7:30 am to 5:30 pm. The designated director/site supervisor for the facility is Sheryl Chan. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: Facility has three main classrooms (classrooms 1, 3, and 4). Total useable indoor square footage of the three classrooms is 3,216.26 sq ft divided by 35 sq ft equals 91 children. There is a total of six toilets and ten sinks accessible for children's use. Total allowable capacity for toilets is 90 and sinks is 150 .

Each classroom is observed today to be clean and all furniture, toys, and equipment observed to be safe and in good condition. There is storage space for children's personal belongings and cots to be utilized for napping children. There is a fire alarm system throughout the facility. Each classroom is equipped with a fire extinguisher and a smoke and carbon monoxide detector. Garbage cans have tight-fitting lids. First aid kit and emergency supplies are located in each classroom inaccessible to children. The facility is adequately ventilated.

There are two bathrooms located next door to classroom 3 with three toilets and two sinks in each bathroom. Children will be escorted to the bathroom by staff. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children in all classroom deliver water that is no warmer than 120 degrees. There is a separate bathroom for staff usage on the premises.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2022
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: ANNE CAMPBELL CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 414004898
VISIT DATE: 08/09/2022
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Facility will utilize classroom 2 as a sensory room for indoor gross motor skills for children with individual development needs as specified in their education plans and will also be used during rainy days and spare the air days when applicable. This room will not be included in the measurement of total capacity for the license. Classroom 2 measures at 929.21 sq ft divided by 75 sq ft equals 12 children. A waiver request was received to utilize classroom 2. Applicant stated only one classroom will be opened at this time but a rotation schedule will be provided for the room prior to use when another classroom is opened.

Facility will also utilize multipurpose room for indoor use for facility assemblies and guest presenters and also as another alternative for outdoor space during rainy days and spare the air days. This room will not be included in the measurement of total capacity for the license. If multipurpose room is utilized as an alternate to outdoor space, room measures at 1,754.17 sq ft divided by 75 sq ft equals 23 children. If multipurpose room is utilized as an indoor space for facility assemblies and guest presenters, room measures at 1,754.17 sq ft divided by 35 sq ft equals 50 children. A waiver request was received to utilize multipurpose room as an indoor space and alternative to outdoor space. Applicant stated only one classroom will be opened at this time but a rotation schedule will be provided for the room prior to use when another classroom is opened.

Outdoor: There is a main playground and two side patios for outdoor use at the facility. Main playground measures at 8,712 sq ft. divided by 75 sq ft allowing for a total of 116 children. Facility will share the main playground with another licensed facility already on premises, Stella Piccolo Preschool (license #414001655). LPA received a waiver request from Applicant for a rotation outdoor play schedule with the other licensed facility to use the outdoor area at specific times. The outdoor area is enclosed by over a four foot fence and observed to be clean, safe and equipped with age appropriate toys and equipment for children. Resilient material is located on the ground of the play area and underneath the play structure. Play structure is age appropriate and is in good condition. Teachers will bring out children's reusable cups filled with water while outside. Shade is available through an overhead awning from the building and an awning over the play structure.

Side patio located next to classroom 1 and 3 measures at 2,189.63 sq ft divided by 75 sq ft allowing a total of 29 children. Side patio located next to classroom 2 and 4 measures at 1,632 sq ft divided by 75 sq ft allowing a total of 21 children. The outdoor areas to be used is enclosed by a four foot fence and observed to be clean, safe and equipped with age appropriate toys and equipment for children. Shade for children will be provided by the building.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
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: ANNE CAMPBELL CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 414004898
VISIT DATE: 08/09/2022
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LPA will approve licensure of facility for the capacity of 40 children as of today, August 9, 2022. Fire clearance inspection was conducted on August 8, 2022 and requested capacity was granted. LPA received original copy of STD 850 form from Applicant.

Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff hired. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until the translation is available.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] 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 plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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 reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
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: ANNE CAMPBELL CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 414004898
VISIT DATE: 08/09/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Sheryl Chan.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
LIC809 (FAS) - (06/04)
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