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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210108890
Report Date: 08/17/2021
Date Signed: 08/17/2021 03:02:55 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.(CFS)-OLD GALLINAS CHILDREN'S CENTER (PS)FACILITY NUMBER:
210108890
ADMINISTRATOR:LOMBARDI, KELSEYFACILITY TYPE:
850
ADDRESS:251 NORTH SAN PEDRO ROADTELEPHONE:
(415) 472-1663
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:180CENSUS: 0DATE:
08/17/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kelsey Lombardi & Iris Marin-LimaTIME COMPLETED:
03:30 PM
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On 8/17/21., Licensing Program Analyst (LPA), Farhan Bashir-Tariq met with Operations Director, Kelsey Lombardi (S1) and Site supervisor, Iris Marin (S2) to conduct a case management inspection. This inspection was initiated by the facility. Purpose of the inspection was explained and is to review and measure the rooms for this preschool. Facility is a combination center and operates school age and preschool program at this site. This preschool program will run in the following rooms: Room #1, #2, #3, #4, #5, #6, #7, #8 and #10. This program will operate from Monday to Friday between 7:30 AM to 6:00 PM. Facility is part of food program and will provide breakfast and snacks at this point. Facility made changes to their classrooms for this program. Only indoor space was measured at this point. Facility will continue to follow previous restrictions for outdoor space.

LPA along with S1 and S2 inspected all the classrooms for health and safety hazards. LPA also measured the classroom for capacity change. LPA observed that there were multiple smoke detectors, carbon monoxide detectors and fire extinguishers available at the site in classrooms and in corridors. A working telephone was available in each classroom. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. All toilets, hand washing facilities are in working condition with proper sanitation in place. Staff bathrooms were available in building A and office building. LPA measured all the classrooms. Total area of all rooms adds up to 8595 sqft. Facility has 12 sinks and 12 toilets available to be used by preschool children. Based on the measurement taken and restrooms availability, a preschool license with a capacity of 180 children will be recommended for approval. License will be pending until fire clearance has been received from San Rafael Fire Department.

This report and rights to comment and appeal were discussed with S1 and S2. This report must be available in the facility for public review. Notice of site inspection was posted. Facility 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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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