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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004909
Report Date: 08/16/2022
Date Signed: 08/16/2022 11:07:54 AM

Document Has Been Signed on 08/16/2022 11:07 AM - 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:AFTERSCHOOL CARE ENRICHMENT (ACE) @ WHITE OAKSFACILITY NUMBER:
414004909
ADMINISTRATOR:YOUSEF, ELYSEFACILITY TYPE:
840
ADDRESS:1901 WHITE OAK WAYTELEPHONE:
(650) 921-2948
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/16/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Eve Daskalakis & Elyse YousefTIME COMPLETED:
11:15 AM
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On August 16, 2022 at approximately 9:00am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an announced, pre-licensing inspection. LPA met with applicant, Eve Daskalakis, and director, Elyse Yousef. The purpose of the inspection was explained. The applicant is requesting a school age license for 60 children (Tk to 5th grade). The facility will operate Monday through Friday from 7:30am to 9:30am, 1:25pm to 6:00pm and Wednesdays 12:25pm to 6:00pm.

The after school program will operate on White Oaks Elementary school site of San Carlos school district. The designated director of the site will be Elyse Yousef. Fire clearance was obtained 07/27/2022. The facility was inspected, indoors and outdoors, for health and safety hazards.

Indoors: The school age program is exempt from requirements for indoor and outdoor space square footage, fencing, and toilet/sink ratios. No measurements were taken during the inspection. The programs will operate out of classroom #7, #8, and Multi-purpose room only. Applicant plans to store children's belongings in cubbies located outside the classrooms. Each classroom is equipped with a carbon monoxide detector and smoke detector. Entire facility has a fire alarm system installed and implemented by school district. Both classrooms are equipped with fully charged fire extinguishers. Medications with required documents and emergency supplies will be stored in classrooms' high shelves, locked behind child safety locked cabinets. Emergency backpacks are also available in each classroom that will be brought from indoors to outdoors. Each classroom has a garbage can with tight fitting lids.

All toxins and hazardous items will also be stored in locked cabinets, inaccessible to children. Isolation for a sick child will be in the classroom, separate from other enrolled children. Restrooms are located outside the classrooms, next to the multi-purpose area. Restrooms allow for individual privacy. LPA observed restrooms to be in proper working condition. Program will use school district garbage cans and bins that will be disposed of daily by school district site's janitorial services.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: AFTERSCHOOL CARE ENRICHMENT (ACE) @ WHITE OAKS
FACILITY NUMBER: 414004909
VISIT DATE: 08/16/2022
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Program will provide breakfast during morning program, lunch during early dismissal, and dry, afternoon snacks daily. Applicant and director are aware food is not to be stored near toxins and poisons. Water is accessible to enrolled children with multiple, accessible water fountains and refillable pitchers with disposable cups.

Outdoors: Program has exclusive access and use of entire playground located outside the classrooms. Outdoor includes two playgrounds, basketball court, and field. Entire outdoor area of the school is enclosed by a fence that is at least four feet tall. Separate after school program will also operate on elementary school site that is separate from ACE program. Applicant and director area aware children from separate after school program are not to co-mingle with children with ACE program.

LPA observed playgrounds to be clean, safe and equipped with climbing structures appropriate for children's age group. Resilient padding is installed under climbing, play structures. Applicant and director are aware enrolled children using the playgrounds will always be supervised and monitored.

Applicant and director are aware disaster drills are to be conducted at least once every six months and properly logged and maintained. All required licensing documents and posters are properly posted in entrance of classroom #7, available for review.

At approximately 10:30am, applicant had to leave pre-licensing inspection due to a pre-scheduled appointment. Applicant allowed LPA to complete inspection with director. Applicant is aware director's signed signature on reports acts as applicant's signature.

Director 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 reviewed with director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
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: AFTERSCHOOL CARE ENRICHMENT (ACE) @ WHITE OAKS
FACILITY NUMBER: 414004909
VISIT DATE: 08/16/2022
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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.

After today's visit, LPA will approve for a license effective today's date, for requested capacity of 60 children.

Exit interview conducted and report was reviewed with director, Elyse Yousef.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC809 (FAS) - (06/04)
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