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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210102934
Report Date: 09/05/2019
Date Signed: 09/05/2019 02:10:44 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:SAUSALITO NURSERY SCHOOLFACILITY NUMBER:
210102934
ADMINISTRATOR:MILLER, DIANAFACILITY TYPE:
850
ADDRESS:625 MAIN STREETTELEPHONE:
(415) 332-0174
CITY:SAUSALITOSTATE: CAZIP CODE:
94965
CAPACITY:40CENSUS: 4DATE:
09/05/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Diana Miller TIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Van met with Director, Diana Miller, for an announced inspection of Plan of Correction (POC). The purpose of the inspection was explained and was granted entry to the facility by staff. Present, there are 4 children and 2 teachers.

On July 16, 2019 annual inspection, facility was cited for not having fingerprint clearance for one of the teachers working at the facility. In today's POC inspection, LPA inspected the facility for health and safety to verify the correction of the previous deficiency.

At 1:45 P.M., LPA reviewed Facility Personnel Summary Report and confirmed that this teacher now has cleared fingerprint clearance. The deficiency that was cited on July 16, 2019 is cleared.

An exit interview was conducted with director. A consultation provided. No deficiencies are cited today. A copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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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