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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210108889
Report Date: 08/12/2022
Date Signed: 08/12/2022 04:22:32 PM


Document Has Been Signed on 08/12/2022 04:22 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:C.A.M.(CFS)-OLD GALLINAS CHILDREN'S CENTER (SA)FACILITY NUMBER:
210108889
ADMINISTRATOR:LOMBARDI, KELSEYFACILITY TYPE:
840
ADDRESS:251 NORTH SAN PEDRO ROADTELEPHONE:
(415) 479-2771
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:45CENSUS: 20DATE:
08/12/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Iris MarinTIME COMPLETED:
04:30 PM
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 On August 12, 2022, Licensing Program Analysts (LPAs) Van and Garcia made a scheduled case management inspection and met with Site Manager Iris Marin. This is a combination center with a preschool and school-age programs at the same address. The Licensee requested to add classroom #7, previously licensed to the preschool program, to be used for the school-age program, and increase capacity for the school-age program from 45 to 69 children. Today, five teachers are supervising 20 children.
During the inspection, the facility was inspected for health and safety hazards. Specifically, room #7 was measured to ensure the square footage of the classroom is sufficient for the increase from 45 to 69 requested capacity. The square footage of room #7 is 933.77 sq ft subtracting 108 encumbered spaces, which means the total available usable space is 825.77. With the Licensing requirement of 35 sq ft indoor activity space per child, room #7 can accommodate approximately 24 children. The classroom has a centralized fire alarm, a smoke and carbon monoxide detector, and a fully charged fire extinguisher. There are toys, furniture, and equipment available for children. There is a storage space for children's personal belongings. The school-age program has a total of 5 toilets, two urinals allowing for 105 children, and 6 sinks allowing for 90. There are no changes in the outdoor space.
The new school-age classrooms with the addition of classroom #7 are #26 and #28.
A fire clearance inspection was conducted by the Marin Fire Department and approved.
Based on the new square footage, the request to increase the capacity to 69 children will be granted today, August 12, 2022.
The report was reviewed and discussed with the Site Manager, Iris Marin. A copy of the report was provided. No deficiencies are cited today under the California Code of Regulations, Title 22, Division 12.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2022
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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