Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410519011
Report Date: 03/03/2016
Date Signed 03/03/2016 03:32:19 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-PONDEROSA AFTER SCHOOL REC PROGRAMFACILITY NUMBER:
410519011
ADMINISTRATOR:MULKERRINS, MICHAELFACILITY TYPE:
840
ADDRESS:295 PONDEROSA ROADTELEPHONE:
(650) 873-1096
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:120CENSUS: 23DATE:
03/03/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Cristina RodriguezTIME COMPLETED:
03:45 PM
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(3) LPA Andrea Medlin met with staff and Kelli Jo Cullinan, Recreation and Community Services Supervisor, and Laura Armanino, Assistant Child Care Supervisor for this random annual licensing visit today. Purpose of the visit explained. There were 23 children and several teachers present. Facility meets teacher-child ratio today. Physical plant toured, including the classroom used for the program, and outdoor play areas to inspect for health and safety hazards. Children's bathrooms inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. There are staff bathrooms present. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per director, 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 classrooms. Classrooms are set up for child care, furniture and equipment for children are available as well. If a child is taking medication, it is stored in an inaccessible location to children. Center provides snacks. 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 soft cushioning. Outdoor activity space surfaces are free of hazards. Shaded outdoor areas are available. Facility has posted all the required licensing forms (License, Notification of Parent's Rights, Notification of Personal Rights, Earthquake preparedness checklist, and Emergency Disaster Plan). LPA reviewed staff and children's files. In the files that were reviewed, all children had Identification and Emergency information on file. The last emergency disaster drill was conducted on 2/24/16 and is appropriately documented. In the staff files, all had current Pediatric First Aid and CPR on site; staff have documentation of the appropriate educational requirements, and a health screening. All children were observed to be signed in today. No health and safety hazards were observed today. The facility appears to be clean and well maintained.

This report was reviewed with Recreation and Community Services Supervisor and a copy of this report must be available for public review upon request.

Notice of Site Visit was observed to be posted and 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: 03/03/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2016
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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