Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410517854
Report Date: 06/03/2016
Date Signed 06/03/2016 03:46:20 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:A CHILD'S WAYFACILITY NUMBER:
410517854
ADMINISTRATOR:LAWSON, NANCI ROTHFACILITY TYPE:
840
ADDRESS:801 HOWARD AVE.TELEPHONE:
(650) 342-3460
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:70CENSUS: 46DATE:
06/03/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Ramona HernandezTIME COMPLETED:
04:15 PM
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3, Licensing Program Analyst, LPA Yee conducted an Annual/Random visit today. Present were 46 children and six staff members. This is a combination center licensed for school age program and preschool program. Facility operates in room 16, 17 and library. Drinking water is readily available for indoor and outdoor. Incidental Medical Services plan was discussed. The school has one child that is on medication. Child file was reviewed. Dr. note is on file. Staff said she will obtained parent note and will put it in the child's file. There are plenty of age appropriate toys and equipment available for children. Discipline policy was discussed. CPR & 1st aid certificate is current which expires 8/19/17. This facility is located at Washington elementary school. The facility follows elementary school schedule. The facility will be closed from mid June thru mid August. Smoke detector, carbon monoxide detectors are available and working. Staff files and children files were reviewed during the visit. Facility personnel summary report was reviewed and correct. Current LIC500 was obtained today. Facility is in compliance today.

Office: (650) 266-8800

website: www.ccld.ca.gov. Title 22, Div 12, Chp 1
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2016
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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