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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505549
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:24:02 PM

Document Has Been Signed on 02/15/2023 12:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ALEXANDER, BARBARA - BELVEDERE MONTESSORIFACILITY NUMBER:
380505549
ADMINISTRATOR:ALEXANDER, BARBARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 564-3173
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Barbara AlexanderTIME COMPLETED:
12:35 PM
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On February 15, 2023 at 10:00 AM, Licensing Program Analyst (LPA) Nathan Garcia arrived at the facility to conduct an unannounced Annual Inspection and met with the Licensee, Barbara Alexander. Purpose of the inspection was explained. There were 7 children present in the home. LPA verified the background check clearance of the adults working or living in the home. The hours of operation are Monday through Friday, 07:30 AM- 5:30 PM. Licensee provides AM snacks, and PM snacks, which are all prepped and served at the facility. Lunch is provided by parents and brought from home.

Daycare areas: Living room day care area and bathroom with 2 toilets and backyard.
Off Limit areas: Entire Upstairs
LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care.
LPA and Licensee inspected the entire childcare area for Health and Safety hazards. There are multiple carbon monoxide and smoke detectors located in each room. LPA perform the tests to check the functionality of the detector and Licensee provided battery replacement. One fully charged fire extinguisher of size 3A40BC was also available in the home, located in the kitchen. First Aid kit is fully stocked and accessible, located in the bathroom. Licensee states, there are no pools, weapons/guns in the home. There are two pet cats in the home.

LPA observed that the house is in good repair and free of hazards with proper temperature and ventilation and lighting. The play area is clean, padded/carpeted and in good condition. LPA observed that there are variety of age-appropriate toys, books, and other learning materials available in the home. Electric outlets have proper covers and a working phone is on site. The Licensee used to have insurance but was stopped during the pandemic. LPA advised to have LIC 282 be available. LPA observed that the day care area also has a gardening area and paint materials for art activities.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ALEXANDER, BARBARA - BELVEDERE MONTESSORI
FACILITY NUMBER: 380505549
VISIT DATE: 02/15/2023
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All posting requirements are met and posted near the childcare entrance. Licensee does not have current and valid CPR and First Aid certification. Mandated reporter training certificate are not valid and will be a Technical Violation. LPA reviewed facility records. The facility conducts fire and earthquake drills with the children at least once a month. The most recent one was on 2/7/23.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Per Licensee, there are no children enrolled with allergies. Incidental Medical Services (IMS) policy was discussed. For IMS information Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: on see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the www.ada.gov/childqanda.htm.



The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.



LPA encouraged the Licensee to visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at [email protected] and ask to be added to the email list for the updates.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PENINSULA CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ALEXANDER, BARBARA - BELVEDERE MONTESSORI
FACILITY NUMBER: 380505549
VISIT DATE: 02/15/2023
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.


LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Technical Violation for Mandated Reporter Training.

Type B violation for expired CPR certification.

A copy of this report was given to the Licensee and a site visit notification must be posted for 30 days.



Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Barbara Alexander.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/15/2023 12:24 PM - It Cannot Be Edited


Created By: Nathan Garcia On 02/15/2023 at 11:57 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALEXANDER, BARBARA - BELVEDERE MONTESSORI
FACILITY NUMBER: 380505549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above for not having valid CPR certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2023
Plan of Correction
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LIcensee will provide valid CPR certification by due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Nathan Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


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