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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210108890
Report Date: 10/22/2021
Date Signed: 10/25/2021 10:45:18 AM

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: 70DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Iris Marin-LimaTIME COMPLETED:
05:00 PM
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On 10/22/21 at 12:30 pm., Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced to conduct a required one-year inspection and met with site Director, Iris Marin-Lima. Purpose of the inspection was explained. Facility currently have 86 children enrolled in preschool program, out of which 70 children were present today. Facility is complying to staff and child ratio. LPA verified the background check clearance of staff present today. Facility is a combination center that runs preschool and school age programs at this site. This preschool program runs in the following rooms: Room #1, #2, #3, #4, #5, #6, #7, #8 and #10. Hours of operation are: M-F, 7:30 am – 6:00 pm. Facility is part of food program and provides breakfast, lunch and two snacks.

LPA and Director inspected the facility indoors and outdoors for health and safety hazards. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. Facility has multiple carbon monoxide detectors and smoke detectors available in all classrooms. LPA tested function of one of the detectors during this inspection. Multiple fire extinguisher of size 2A10BC or bigger were also available in classrooms and hallway. A working telephone was available at the facility. First aid kit and emergency supplies were fully stocked and accessible. Per Director, there are no firearms/weapons or pets kept at the facility. Director stated that there are no bodies of water or swimming pools located at the facility. LPA observed that the facility is in good repair and free of hazards with proper temperature and ventilation. Classroom floors were observed to be clean. Furniture was steady and in good repair. LPA observed that there is a variety of age appropriate toys, books, arts, puzzles and other learning material available in classrooms for children in care. Electric outlets in classrooms were securely protected with child safety covers. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Multiple toilets and sinks were available within the facility in the main building and in classrooms to meet the required numbers. Hand washing posters were observed in bathroom. All toilets, hand washing facilities are in working condition with proper sanitation in place. All storage containers for solid waste and in good repair and have proper tight fitted lid on top. Facility has drinking water available for children both indoors and outdoors.
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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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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.(CFS)-OLD GALLINAS CHILDREN'S CENTER (PS)
FACILITY NUMBER: 210108890
VISIT DATE: 10/22/2021
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Facility has multiple outdoor spaces available for children to be used. All outdoors spaces were fully fenced all around. Play structures were observed in outdoor space. All of the play structures were steady, in good repair and free of any loose parts. There was sufficient amount tan bark available under the play structures to prevent any falls or injuries injuries. Per Director, Discipline policy is redirection or communication. Facility was in compliance to address COVID related issues following the Licensing and local county guidelines. Staff were observed to be wearing masks around children. COVID 19 symptoms, social distancing and other useful information posters were observed to be posted in the facility hallway and classrooms. Masks, cleaning wipes and sanitizers were available in classrooms. All required postings were met. Posters for parents’ rights, emergency disaster plan, license, facility fire drill log and emergency evacuation plans were observed to be posted in each classroom.

LPA reviewed facility records. LPA reviewed 12 random children's and 7 random staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Each child's file contains record of immunization. Multiple staff members have current and valid CPR and First Aid cards in files. Mandatory child abuse training certificates were also observed in staff’s files. LPA reviewed the educational qualification of the teachers.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility does not have any child on medication at present. However, Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm


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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
Page: 3 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.(CFS)-OLD GALLINAS CHILDREN'S CENTER (PS)
FACILITY NUMBER: 210108890
VISIT DATE: 10/22/2021
NARRATIVE
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

LPA reminded Director, as of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. LPA encouraged facility Director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.


>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

An exit interview was conducted. 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 visit was given and must remain posted for 30 days from today's visit. Facility was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov

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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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