Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001244
Report Date: 06/09/2016
Date Signed 06/09/2016 02:56:24 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:CLUB HAPPY HALL, ROLLINGWOODFACILITY NUMBER:
414001244
ADMINISTRATOR:BOU-KHALIL, MARIAFACILITY TYPE:
840
ADDRESS:2500 COTTONWOOD DRIVETELEPHONE:
(650) 616-9054
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY:35CENSUS: 26DATE:
06/09/2016
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria Bou-Khalil, Mary Lou JohnsonTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Andrea Medlin met with site director, and later Licensee/owner, for this case management visit due to a request to increase capacity to 60 children. Facility is licensed to serve school aged children on the Rollingwood Elementary School site through the San Bruno Park School District (SBPSD). Days and hours of operation: Monday-Friday 7:00AM-morning bell and dismissal bell until 6:00PM. The facility currently operates their program in classroom #15 and will add the multipurpose room. This is a functioning school site, therefore facility is exempt from the following: indoor square footage, fencing, outdoor activity space, toilets, and isolation space requirements. The facility has exclusive use of playground during their scheduled time. There is a fire extinguisher, smoke detector, and a carbon monoxide (CO) detector present. Copy of superintendent certification obtained during the visit. Physical plant toured, including the classroom used for the program and the multipurpose room. 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. Shaded outdoor areas are available. Two separate bathrooms for children are present across the hall. Staff bathrooms are available. 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 classroom. Classroom is set up for child care, furniture and equipment for children are available as well. Center provides snacks and a sample menu is available and posted. First aid supplies are available. Sick children will be separated from the group and wait for parents to pick up. Facility has posted all the required licensing forms in the classroom. No apparent health and safety hazards were observed during the visit.

This program meets the licensing requirements to increase to 60 today and licensure is recommended and approved as of today, 6/9/2016.

This report was reviewed with Licensee and a copy of this report must made be available for public review upon request.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2016
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 1