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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210108890
Report Date: 06/06/2023
Date Signed: 06/06/2023 10:27:29 AM


Document Has Been Signed on 06/06/2023 10:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 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:MARIN, IRISFACILITY TYPE:
850
ADDRESS:251 NORTH SAN PEDRO ROADTELEPHONE:
(415) 472-1663
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:160CENSUS: 44DATE:
06/06/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Iris MarinTIME COMPLETED:
10:40 AM
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On 6/6/2023, Licensing Program Analyst (LPA) Hanson Leong, made a scheduled case management visit to the child daycare facility listed above. This facility operates a preschool and school-age program at the same location (license number 210108889). The Department has received an application from the Licensee requesting a capacity reduction for the preschool program. Room #6 is the one that will be removed from the preschool program. The LPA observed sixteen staff members supervising forty-four preschool aged children. Children's capacity and ratio requirements were observed to be in compliance.

During today’s visit, the facility was checked for any health and safety concerns. Room #6 was specifically surveyed to ensure that the classroom's square footage was sufficient for the requested capacity reduction. The total accessible useable space is 867 sq ft. Room #6 can accommodate roughly 24 children due to the licensing requirement of 35 sq ft indoor activity space per child. There is a centralized fire alarm, a smoke and carbon monoxide detector, and a fully charged fire extinguisher in the classroom. Toys, furniture, and equipment are offered for children. There is a storage area for children's personal items. The preschool program contains 11 toilets that can accommodate 165 children and 17 sinks that can accommodate 255 children. There have been no alterations to the outdoor area. With the loss of classroom #6, the new Preschool classrooms are #1, #2, #3, #4, #5, #8, and #10.

A fire clearance inspection was conducted by the Marin County Fire Department and approved on 5/26/2023.



The LPA will approve a reduction in capacity to 140 children, effective on 6/6/2023.

Today's report was reviewed and discussed with the Site Director, Iris Marin. A copy of today’s report and the “Notice of Site Visit” were given to Iris Marin. No deficiencies were cited today under the California Code of Regulations, Title 22, Division 22

SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson LeongTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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