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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102848
Report Date: 11/08/2024
Date Signed: 11/08/2024 03:57:03 PM

Document Has Been Signed on 11/08/2024 03:57 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 PRESCHOOLFACILITY NUMBER:
210102848
ADMINISTRATOR/
DIRECTOR:
CRISELDA THOMASFACILITY TYPE:
850
ADDRESS:2000 LAS GALLINAS AVENUETELEPHONE:
(415) 479-4140
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: 60TOTAL ENROLLED CHILDREN: 35CENSUS: 20DATE:
11/08/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Criselda ThomasTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 11/8/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit and met with the Director, Criselda Thomas. LPA explained the purpose of the visit to the director.

Twenty preschool-aged children and six staff members were present during the visit. The six staff members received criminal record clearance from the department. The facility is within its capacity limits and ratios for today’s visit.

LPA observed that all required documents, such as the facility license, waivers, notification of parents’ rights, personal rights, car seat laws, emergency disaster plan, and daily activities schedule, were displayed and visible to the public.

The most recent emergency disaster drill was conducted on 10/29/2024, and the LPA observed that it was properly documented.

The facility was observed to have first aid kits in each classroom, smoke and carbon monoxide detectors, and multiple fully charged fire extinguishers.

LPA inspected the indoor and outdoor areas to identify health and safety hazards. The facility was clean, safe, sanitary, and in good repair. Disinfectants, cleaning solutions, poisons, and other items that could pose a danger were stored in areas inaccessible to the children. All accessible cabinets and drawers in the classrooms were found to be free of hazardous materials or poisons.

LPA observed that the three classrooms had age-appropriate toys, furniture, educational materials, and designated storage space for each child. Electrical outlets were observed to have child safety covers or child tamper-proof locks. One classroom has a diaper-changing table within arm’s reach of a sink. The bathrooms were found clean and fully operational. The toilets and handwashing facilities were well-kept, safe, and clean.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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: 11/08/2024
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The outdoor playground has a fence at least four feet high. The outdoor play equipment is in good condition and has no sharp, loose, or pointed parts. The areas around and under high climbing equipment, swings, slides, and similar equipment were observed to be cushioned with either woodchips or artificial grass. No bodies of water, such as pools or spas, were on site.

The preschool program does not provide lunches for the children. LPA observed that each child had their lunches in their designated storage space. According to the director, some of the enrolled children have allergies.

Sleeping mats and cots are available for children to use when sleeping or napping. According to the director, parents or guardians must provide sheets for their children and wash them weekly.

LPA observed that the facility records each child's attendance on an electronic app, and all parent signatures were accounted for each child. LPA reviewed ten children’s files and confirmed that all ten have complete files, which included their emergency contact and medical information.

LPA reviewed the files for five staff members and confirmed that all five were current with their Pediatric First Aid/CPR certifications. LPA also found that all five had completed the necessary twelve units in Early Childhood Education (ECE), which meets the qualifications required to be classified as a teacher. LPA found one staff member did not complete their Mandated Reporter Training and requested the director email it to the department once the staff member completes it.

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.

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

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.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 11/08/2024
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LPA discussed the safe sleep regulations with 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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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-care-centers

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 issued today during LPA's visit.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Criselda Thomas.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
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