414004909-9-14-2023-05-CC-MOLN-CVNTHX-20230914144528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004909
Report Date: 09/14/2023
Date Signed: 09/14/2023 02:46:36 PM

Document Has Been Signed on 09/14/2023 02:46 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 (ACE) @ WHITE OAKS		FACILITY NUMBER:	414004909
ADMINISTRATOR:	YOUSEF, ELYSE		FACILITY TYPE:	840
ADDRESS:	1901 WHITE OAK WAY		TELEPHONE:	(650) 921-2948
CITY:	SAN CARLOS	STATE: CA	ZIP CODE:	94070
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 0	CENSUS: 23	DATE:	09/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:32 PM
MET WITH:	Tina Nguyen		TIME COMPLETED:	03:10 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	On September 14, 2023, at @ 12:32PM Licensing Program Analyst (LPA) Maria Olguin-Leon met with Director, Tina Nguyen for an unannounced annual inspection. Purpose of inspection was explained. Present today was Director, 6 staff and 23 school age children. Director Victoria Ruiz 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 9:30 AM 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 White Oaks Elementary School site in classroom #7 and #8. Classrooms are clean with proper ventilation. There are plenty of age-appropriate toys/games, books, furniture and learning materials all in good repair. There are cubbies available inside and outside 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 two large play structure 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 kitchenette cabinet. 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: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: AFTERSCHOOL CARE ENRICHMENT (ACE) @ WHITE OAKS	FACILITY NUMBER: 414004909
	VISIT DATE: 09/14/2023

NARRATIVE

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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 drill was conducted on 09/01/2023. Per Director there are no firearms or weapons on site.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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) 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 childcare 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).

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SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: AFTERSCHOOL CARE ENRICHMENT (ACE) @ WHITE OAKS	FACILITY NUMBER: 414004909
	VISIT DATE: 09/14/2023

NARRATIVE

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LPA referred ACE @ White Oaks to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

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.

The following Type B violation (potential health, safety, or personal rights risk to children in care.) was cited for today’s visit. 1. HSC 1597.16(a)(1)- A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test

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 Director Victoria Ruiz.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/14/2023 02:46 PM - It Cannot Be Edited

Created By: Maria Olguin-Leon On 09/14/2023 at 02:30 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: AFTERSCHOOL CARE ENRICHMENT (ACE) @ WHITE OAKS	FACILITY NUMBER: 414004909
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 10/16/2023
	Plan of Correction
1 2 3 4	The facility must have lead testing completed and submit a copy of a completed LEAD water report to the department by the above due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Marie Rodriguez

LICENSING EVALUATOR NAME:

Maria Olguin-Leon

LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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