Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002261
Report Date: 10/20/2017
Date Signed 10/20/2017 02:10:32 PM

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:PEEKADOODLE ACADEMY PRESCHOOLFACILITY NUMBER:
384002261
ADMINISTRATOR:KAYLA LEE, PRES./DIR.FACILITY TYPE:
850
ADDRESS:900 NORTH POINT ST., STE. F100TELEPHONE:
(415) 440-7335
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:60CENSUS: 46DATE:
10/20/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Stephanie SalumbidesTIME COMPLETED:
02:00 PM
NARRATIVE
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2, LPA Ng conducted an unannounced random annual visit. LPA met with the new Site Director, Stefanie Stoddard during the visit. Facility is a preschool program center. There are 46 children 12 staff members. Currently the facility is operating classrooms 1, 3, 4, 5, 8 ( formerly classroom 7) . Director states that she has no knowledge of any guns or weapons in the facility. In the classroom furniture and equipment are age appropriate and in good repair. There is adequate heating, lighting and ventilation, however in classroom 5 the temperature was barely making 68 degrees F. which is the minimum per regulations. A carbon monoxide detector was observed, tested and working. Drinking water is readily available via water pitcher and paper cups, there is sufficient space for the group size being served. There are separate toilet and sinks available for staff & children There are sufficient mats for each child bedding accessories are cleaned once a week. Proper staffing ratios are maintained. The bathroom were inspected the toilets flushed and the faucets are working, sinks are reachable by children by the use of step stools, toilet paper, soap and towels are available and the bathrooms are clean. Hot water was tested at 76 degrees F. In regards to food service, the school no longer provides lunch, but either a morning and afternoon snack is provided to the children, parents can order lunch for their children as the facility has their own food prep service, if ordered the food is prepared on site. There is a food prep kitchen area the, the food was inspected for freshness and all items were in compliance, the refrigerator had a reading of 41 degrees. The menu is posted. Health related services was discussed with the director she states medications will not be dispensed except those items that are used for emergencies such as epi-pens, benydrl, nebulizers, etc.) parents will provide a note if there is such a need. director states that medication will be stored in Lock boxes at the front desk and at the cafe refrigerator. First aid supplies, a thermometer and emergency items are available. Isolation is provided in the office with the use of the Plaza bathroom which is located on the 3rd level, if needed. Records of staff were reviewed for qualifications of staff and children's records were reviewed for emergency and identification forms. Facility has posted the required forms (i.e. License, menus, waivers , Notification of Parent's Rights (Updated), Notification of Personal Rights, Car Seat Law (Updated), and Emergency Disaster Plan). Staff persons are current with First Aid/CPR certification expiring 08/20/18. Site Director states Fire and Earthquake drills are conducted with the last one logged on 09/27/17. CONTINUED>>>
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2017
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: PEEKADOODLE ACADEMY PRESCHOOL
FACILITY NUMBER: 384002261
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2017
Section Cited
CCR
101170(e)(2)
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101170(e)(2) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. ( Director fingerprints cleared but not transferred )
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Director states will submit documentation to transfer fingerprint clearance to current facility. Civil Penalty issued.
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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: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2017
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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: PEEKADOODLE ACADEMY PRESCHOOL
FACILITY NUMBER: 384002261
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2017
Section Cited
HSC
1596.7995a1
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§1596.7995(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, & measles. Each employee & volunteer shall receive an influenza vaccination between August 1 & December 1 of each year.
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Director states that all immunization records will be available by due date.
Type B
10/27/2017
Section Cited
CCR
101212c
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The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions.
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Director states that she will submit documents to update facility records as well as submit a waiver request to match current facility environment.
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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: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2017
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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: PEEKADOODLE ACADEMY PRESCHOOL
FACILITY NUMBER: 384002261
VISIT DATE: 10/20/2017
NARRATIVE
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Regarding discipline the director states that the policy is positive reinforcement, preventative discipline and redirection. The facility has an outdoor space there are ample toys and activities for children. The outdoor area has a play structure, the structure was observed to needing some tightening of screws. The flooring material is of a soft rubber surface. The facility also enhances its outdoor space with 1 large indoor gross motor space. The a field trip, director states that children wear safety vests and are under the ratio of 1:6. The small gross motor space area has become classroom 3. LPA also went over all new regulations with the new director ( IMS, immunization, Toddlers, Civil penalties, smoking prohibition, Pesticides (DPR.ca.gov), and Childhood Nutrition training.
PESTICIDES:
Pesticide regulations were discussed with the director, In accordance with the Healthy Schools Act, California law requires that anyone using any pesticide must be trained every year in integrated pest management and the safe use of pesticides around children. The director was advised that a free one hour online course is available on the Department of Presticide Regulation's Web site: www.cdpr.ca.gov/schoolipm/training. If the director had questions she can email ccipmlist@cdpr.ca.gov.

FACILITY IS PROVIDING IMS: This facility provides Incidental Medical Services – IMS. LPA reviewed 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, Section 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. Facility has two child using IMS, file was reviewed and complete. IMS policy was available and provided to LPA.

Immunizations: Facility was also informed that as of September 1, 2016, a person may not be employed or volunteer at a child care 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. All staff have proof of Immunization.

LPA observed Site Director posting the Notice of Site Visit. The report was reviewed with the new director.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Tony NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2017
LIC809 (FAS) - (06/04)
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