210108890-10-20-2022-05-CC-HLEG-CKDRE7-20221020125705

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210108890
Report Date: 10/20/2022
Date Signed: 10/20/2022 12:57:09 PM

Document Has Been Signed on 10/20/2022 12:57 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, KELSEY		FACILITY TYPE:	850
ADDRESS:	251 NORTH SAN PEDRO ROAD		TELEPHONE:	(415) 472-1663
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	160	CENSUS: 54	DATE:	10/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Iris Marin		TIME COMPLETED:	12:57 PM

NARRATIVE

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On 10/20/2022, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the C.A.M Old Galinas Preschool facility. The LPA was granted entry by the Director, Iris Marin. The LPA explained the purpose of the visit to the director. Guardian, the department's system for conducting background checks, has confirmed that all the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. The LPA observed twenty two staff members supervising fifty-four children. Children's capacity and ratio requirements were observed to be in compliance

LPA and the director both performed comprehensive inspections of the facility to look for possible threats to health and safety. The facility offers a first aid kit that is completely loaded with everything that is required for the treatment of wounds and other types of injuries. Toys, furnishings, and learning materials in all classes are age appropriate. The LPA observed that the playground equipment and outdoor furnishings are in excellent condition. The outdoor play structures are surrounded by rubberized cushions and wood chips, which can cushion any falls that may occur. The LPA noted that there were no bodies of water present at the facility. All poisons, cleaning products, and other potentially harmful substances have been stored in a location that is inaccessible to children. The building is equipped with smoke detectors, carbon monoxide detectors, fire extinguishers that are properly charged, centralized smoke alarms, and phones that are in working order. The director has stated that the facility does not house any firearms or other types of weapons.

The LPA observed that the facility had displayed all the required documents (i.e., license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities).

The LPA reviewed the records of five children. All required forms were in the children’s’ file. The program uses a sign in / out sheet for authorized individuals to sign their children in and out.

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SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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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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: 10/20/2022

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The LPA reviewed the records of six staff members. All required forms were in the staff files. A review of staff records revealed that four staff members are currently certified in CPR and First Aid.

According to the director, the facility satisfies the requirements by carrying out simulations of fire and earthquake drills every other month, as well as by documenting their results.

The LPA reviewed the new director's credentials and supporting documentation. Following a final review, Iris Marin, the new director, is determined to meet the department's requirements for a director by the LPA.

The 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.

Incidental Medical Services (IMS) policy was discussed with the director. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The LPA encouraged the director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. The director can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates

No deficiencies were issued today. A copy of this report, and the “Notice of Site Visit, “were given to the director. A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with the Director, Iris Marin

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC809 (FAS) - (06/04)

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