Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509769
Report Date: 09/25/2015 12:00:00 AM
Date Signed 09/25/2015 12:13:42 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:CSSF REC DEPT-SIEBECKER CENTERFACILITY NUMBER:
410509769
ADMINISTRATOR:GONZALEZ, DIANAFACILITY TYPE:
850
ADDRESS:510 ELM COURTTELEPHONE:
(650) 875-6979
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:55CENSUS: 29DATE:
09/25/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Aleni Capaz, Laura ArmaninoTIME COMPLETED:
12:20 PM
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(3) LPA Andrea Medlin met with staff and preschool site coordinator for this random annual licensing visit today. Purpose of the visit explained. There were 29 children present. Teacher-child ratio is in compliance. Days and hours of operation: Monday through Friday 7:30AM-6:00PM. Physical plant toured to inspect for health and safety hazards. Center uses the art room, science room, and multipurpose room. Children are divided into three groups: Polliwogs (ages 2.5-3 yrs old), Bears (ages 4-5 yrs old), and Turtles (ages 4-prek yrs old).There are fully charged fire extinguishers that meet minimum requirements, smoke detectors, and a carbon monoxide (CO) detector in the facility. Children's bathroom inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. Separate staff bathrooms are available. No pools, spas, hot tubs, fish ponds, or bodies of water are present. Per staff, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available. Classrooms are set up for child care and furniture and equipment for children is present. Cots are available for napping and are individually labeled; parents provide napping supplies and are responsible to wash once a week. If a child is taking medication, it is logged and stored inaccessible to children. Snacks are provided by the center; parents provide the meals. A sample snack menu is available and posted. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. Outdoor play areas inspected for health and safety hazards. The areas around and under high climbing equipment is cushioned with tanbark. Outdoor activity spaces are enclosed by fences and surfaces are free of hazards. Shaded outdoor areas for children are available. Center has posted all the required licensing forms in a prominent accessible location. Drinking water is readily available by water fountains and through water pitcher and cups during snacks and meals. LPA reviewed staff and children's files. In the children’s files, each child had an admission agreement. In the staff files, each had verification of meeting the educational requirements. All staff have verification of current Pediatric First Aid and CPR certification (exp 2016). Emergency disaster drills are conducted monthly and appropriately logged. No apparent health and safety hazards were observed during the visit. The facility appears to be clean and well maintained.

This report was reviewed with preschool site coordinator and a copy of this report must be made available for public review upon request. Notice of site visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8843
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8843
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2015
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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