210102848-1-29-2024-05-CC-HLEG-CZXVWQ-20240129154819

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210102848
Report Date: 01/29/2024
Date Signed: 01/29/2024 03:48:26 PM

Document Has Been Signed on 01/29/2024 03:48 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MARIN FORMATIVE CHRISTIAN PRESCHOOL		FACILITY NUMBER:	210102848
ADMINISTRATOR:	WARD, JANET		FACILITY TYPE:	850
ADDRESS:	2000 LAS GALLINAS AVENUE		TELEPHONE:	(415) 479-4140
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	60	CENSUS: 13	DATE:	01/29/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:09 PM
MET WITH:	Janet Ward		TIME COMPLETED:	04:03 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	On 1/29/2024, Licensing Program Analyst (LPA) Hanson Leong made an unannounced required visit to the child care center listed above. The LPA attempted to visit the center on 1/4/2024. The LPA was granted entry by the Director. Janet Ward. The director was informed of the reason for today's visit by the LPA. Present in the center included the director, 5 staff members, and 13 preschool-aged children. All individuals present in the center have received fingerprint clearance to work or be in a childcare center. The center is operating within its capacity and in accordance with the required ratio of staff to children. LPA and the director carried out an inspection to identify any possible hazards to health and safety. The LPA observed that the center maintains a written record of the children's attendance, with corresponding parental signatures, and all enrolled children are accounted for during the day. The center provides a first aid kit containing all necessary wound care supplies and other injuries. The LPA observed that the classrooms were equipped with age-appropriate toys, furniture, and educational materials. LPA identified that the equipment and furniture in the outdoor playground appeared to be in excellent condition. The LPA found that the center did not have any pools, spas, or other types of bodies of water of any kind. All harmful and dangerous substances, such as cleaning supplies and chemicals, were kept in a safe place, out of the reach of children. The building has smoke detectors, carbon monoxide detectors, properly charged fire extinguishers, centralized smoke alarms, and operational phones. According to the director, no firearms or other weapons are kept in the center. The LPA observed a designated area intended for children to sleep or rest quietly. The area was found to be equipped with sufficient sleeping mats and cots for each child, and these sleeping mats and cots were stored in an appropriate location. The LPA reminded the director that emergency exits must always remain clear and that sleeping mats cannot be situated in a manner that obstructs emergency exits. The LPA found two diaper changing stations in the center, which were clean and safe for the children to use. See Page 2

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MARIN FORMATIVE CHRISTIAN PRESCHOOL	FACILITY NUMBER: 210102848
	VISIT DATE: 01/29/2024

NARRATIVE

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The LPA observed that all required documents were displayed in the center, such as the facility license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities.

The LPA reviewed of the records of both the children and staff members. The LPA reviewed the files of the five children and confirmed that their admission agreement, Personal Rights Identification and Emergency Information, Physician's Report, Notification of Parents' Rights, and Consent for Emergency Medical Treatment were included in their records. The LPA reviewed the records of the five staff members and confirmed that they were certified in Pediatric First Aid/CPR and Mandated Reporter. The LPA found that five staff members have completed the mandatory 12 Early Childhood Education (ECE) units, which are a prerequisite for qualifying as a teacher.

The LPA reviewed the center’s emergency drill log. The most earthquake drill was conducted on 10/19/2023 and was properly recorded.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

The director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
See Page 3

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC809 (FAS) - (06/04)

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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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MARIN FORMATIVE CHRISTIAN PRESCHOOL	FACILITY NUMBER: 210102848
	VISIT DATE: 01/29/2024

NARRATIVE

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

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. 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/inspection-process

No deficiencies were cited today under CCR, Title 22, Div. 12.

A copy of today’s report was given to Janet Ward. A Notice of Site Visit was given to Janet Ward and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with Janet Ward.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC809 (FAS) - (06/04)

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