Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517130
Report Date: 03/28/2018
Date Signed 03/28/2018 05:19:36 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:HILLSIDE CHRISTIAN ACADEMY (SA)FACILITY NUMBER:
410517130
ADMINISTRATOR:KERRAN, LINDAFACILITY TYPE:
840
ADDRESS:1415 HILLSIDE BLVDTELEPHONE:
(650) 588-6860
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:45CENSUS: 24DATE:
03/28/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Christina ElliotTIME COMPLETED:
05:30 PM
NARRATIVE
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LPA Andrea Medlin met with staff for this random annual licensing visit today. Purpose of the visit explained. There were 24 children present. Days and hours of operation: Monday-Friday 7:00AM-8:15AM and 2:45PM-6:00PM. Physical plant toured, including the areas used for the program, and outdoor play area to inspect for health and safety hazards. There is a fully charged fire extinguisher that meet minimum requirements, smoke detectors, and a carbon monoxide (CO) detector. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. A separate staff bathroom is 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 in the facility. Facility is set up for child care, furniture and equipment for children are available as well. First aid supplies are available. Sick children will be separated from the group and wait for parents to pick up. There are school aged outdoor play areas. The areas around and under high climbing equipment is cushioned with tanbark. Outdoor activity space surfaces are free of hazards. LPA reviewed staff and children's files. In the children's files reviewed, all children had Identification and Emergency information on file. In the staff files reviewed, all had expired Pediatric First Aid and CPR certification; staff have documentation of the appropriate educational requirements. Staff have verification of the required staff immunizations. There is no qualified director here. File reviewed for new director that began acting director as of 11/1/17. Director, Christina Elliot, needs updated Pediatric First Aid and CPR training (expired 2/6/2018), 8 hour health and safety course, required mandated child abuse training as compliant with AB 1207, and the Component 3 orientation: Operation and Record Keeping orientation.

The deficiencies cited on the following pages are in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1:

This report was reviewed with acting director and a copy of this report must be made available for public review upon request. Notice of site visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2018
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: HILLSIDE CHRISTIAN ACADEMY (SA)
FACILITY NUMBER: 410517130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2018
Section Cited
CCR
101216(f)
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101216(f) Personnel Requirements. At least one person trained in CPR and Pediatric first aid shall be present when children are at the facility or offsite activities.
In the staff files reviewed, they have expired Pediatric First Aid/CPR including Director (exp 2/2018)
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The director shall always maintain current Pediatric First Aid and CPR certification. There must be at least one staff on site during operation that has current Pediatric First Aid and CPR training. Submit proof of correction to the licensing office by 4/30/18.
Type B
04/30/2018
Section Cited
HSC
1596.866
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Health and Safety Code 1596.866 Additional health and safety training; For licenses issued on or after January 1, 2016, at least one director or teacher at each day care center, and each provides care, shall have at least one hour of childhood nutrition training (Continued below)
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See below
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family day care home licensee who as part of the preventive health practices course or courses.

Director does not have the required 8 hours Health and Safety Training
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Director to obtain the required 8 hour Health and Safety training certification.

Submit proof of correction to the licensing office by 4/30/18.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2018
LIC809 (FAS) - (06/04)
Page: 2 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: HILLSIDE CHRISTIAN ACADEMY (SA)
FACILITY NUMBER: 410517130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2018
Section Cited
HSC
1596.8662(3)
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H&S Code 1596.8662(3) On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs
(continued below)
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All child care staff shall complete the mandated child abuse reporting training as complaint with AB 1207.

See Below
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(2) and (3) of subdivision (a) within the first 90 days reporter training every wo years that he or she is employed at the facility

Staff do not have required child abuse training as mandated by AB 1207.
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For access to the training:

www.mandatedreporter.ca.com/training/childcare.htm

Submit proof of correction to the licensing office by 4/30/2018.
Type B
04/30/2018
Section Cited
CCR
101212(b)
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REPORTING REQUIREMENT: 101212(b) Reporting Requirements. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence shall be reported to the Department with in 10 days of a change. Change in director not reported to the Department.
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There has been a change in director that occurend in November 2017 and not reported to the Department.

Current Director given a checklist of what is required to be submitted to the Department.
Submit proof of correction by 4/30/18.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2018
LIC809 (FAS) - (06/04)
Page: 3 of 3