210108889-1-9-2020-05-CC-LGOZ-BKP44B-20200109174603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210108889
Report Date: 01/09/2020
Date Signed: 01/09/2020 05:46:10 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:	C.A.M.- OLD GALLINAS CHILDREN'S CENTER (SA)		FACILITY NUMBER:	210108889
ADMINISTRATOR:	MATA, LEYDIS		FACILITY TYPE:	840
ADDRESS:	251 NORTH SAN PEDRO ROAD		TELEPHONE:	(415) 479-2771
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	103	CENSUS: 79	DATE:	01/09/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:	Director, Iris Marin		TIME COMPLETED:	06:00 PM

NARRATIVE

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Licensing Program Analyst, Luis J. Gomez met with Director, Iris Marin and Assistant Director, Elizabeth Martinez. The purpose of the inspection was explained and is for an unannounced annual inspection. This is a school age, after-school program, which operates year-round. The after-school program utilizes four classrooms: #6 (Kindergarten), #8 (1^st grade), #7 (2^nd grade) and #5 (3^rd-4^th grade), and an outdoor play area. Hours of operation are Monday- Friday 2:30pm- 6:00pm, Wednesday 1:30- 6:00pm. Present is the director, assistant director and 9 staff supervising 79 children. Facility is within capacity limits of the license on this day. LPA Gomez inspected facility with director and assistant director for health and safety hazards.

At 3:30pm on January 9, 2020 LPA Gomez inspected classrooms #6, #8, #7, #8, restroom #1, #2 and the outdoor play area. LPA observed the following: Classrooms are clean, orderly and have books, art supplies, wooden blocks and age appropriate materials that are in good repair. Classrooms are equipped with several child size tables and chairs for snack and activities. There is acceptable ventilation and lighting. Each classroom has an emergency disaster kit located at the entrance. All accessible outlets and trash cans are covered. LPA reviewed classroom sign-in sheets during today inspection. Facility has installed child safety locks on all accessible cabinets and drawers in the daycare area. All detergents, cleaning supplies and toxins are made inaccessible to children. Classrooms have a working smoke detector, carbon monoxide detector and fully charged fire extinguisher (3A:40BC), located in the hallway. Restrooms #1,#2, are separated for boys and girls, located in the facility hallway. Per director, staff use a separate restroom. LPA Gomez inspected the outdoor play area for hazards and dangerous conditions. Outdoor play area is completely enclosed and has a play structured that is in good repair. Water is readily available for the children with use of water contains, brought outside during play time. Program provides a daily snack for the children. Children's medication was reviewed and is current.

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SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: C.A.M.- OLD GALLINAS CHILDREN'S CENTER (SA)	FACILITY NUMBER: 210108889
	VISIT DATE: 01/09/2020

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(Page 2)

At 4:45pm on January 9, 2020 LPA Gomez reviewed seven children’s files. LPA observed all files are complete. Staff CPR/ 1^st aid certification is current expiring: 9/2020. All required licensing information is properly posted in facility lobby. Emergency disaster drill are being conducted every 6 months, with the last drill completed: 9/27/2019. LPA reminded director to document each emergency disaster drills.

Incidental Medical Services (IMS) was discussed. For IMS information 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 Department. The following information regarding Americans with Disabilities Act (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: www.ada.gov/childqanda.htm.

During the inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Director was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Director was reminded about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com)
*Director was reminded about the Provider Information Notices (PINs) on CCLD website.

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SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: C.A.M.- OLD GALLINAS CHILDREN'S CENTER (SA)	FACILITY NUMBER: 210108889
	VISIT DATE: 01/09/2020

NARRATIVE

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(Page 3)

Based on today’s inspection, no deficiencies were observed in the areas evaluated according to the Title 22 Division 12 of the Ca. Code of Regulations. An exit interview was conducted with Iris Marin, and her signature acknowledging the receipt of these documents.

>This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site inspection was posted.

Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

LIC809 (FAS) - (06/04)

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