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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210108890
Report Date: 08/12/2022
Date Signed: 08/12/2022 03:11:50 PM


Document Has Been Signed on 08/12/2022 03:11 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 (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: 62DATE:
08/12/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Iris MarinTIME COMPLETED:
02:45 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 program operations at the same address. The Department received an application from the Licensee requesting a decrease in capacity from 180 to 160 children due to removing one of the classrooms currently licensed for the preschool program and using it for the School-age program. The classroom that is removed is room #7. Today, 10 teachers are supervising 62 preschool 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 was sufficient for the decrease from 180 to 160 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 preschool program has a total of 11 toilets allowing for 165 children, and 17 sinks allowing for 255. There are no changes in the outdoor space.
The new Preschool classrooms with the removal of classroom #7 are #1, #2, #3, #4, #5, #6, #8, and #10.

LPAs will approve a decrease of capacity to 160 children once fire clearance has been granted by Fire Inspector and the application has been received/processed.

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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