210110892-8-19-2022-05-CC-BVAN-CHFQRE-20220819122348

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210110892
Report Date: 08/19/2022
Date Signed: 08/19/2022 12:24:04 PM

Document Has Been Signed on 08/19/2022 12:24 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:	CITY OF SAN RAFAEL/VALLECITO SCHOOL AGE		FACILITY NUMBER:	210110892
ADMINISTRATOR:	CERUTTI, PATRICIA		FACILITY TYPE:	840
ADDRESS:	50 NOVA ALBION		TELEPHONE:	(415) 485-3103
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	119	CENSUS: 20	DATE:	08/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Patricia Cerutti and Kelly McGrath		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 19, 2022, Program Analyst (LPA) Van performed an unannounced mandated annual inspection and met with the Director, Patricia Cerutti, and Area Manager, Kelly McGrath. The purpose of the inspection was explained to the Director. This facility is a school-aged after-school program in the Vallecito Elementary School in the City of San Rafael. The school approved the Center to use classrooms #36 and #42, the gym, and the two boys' and girls' bathrooms. The days and hours of operations are Monday to Friday, and the morning program is from 11:30 am to 6:00. At 11:55 am, five children arrive in the classroom. By the time the inspection was completed, the total number of children was 20. The Director and LPA inspected the facility for potential health and safety hazards. All classrooms have age-appropriate games, books, and equipment in good repair. Classrooms have acceptable ventilation and ample lighting. There are cubbies available for children belonging. The facility has a smoke detector, a fully charged fire extinguisher, and carbon monoxide. There are no pools, spas, or other bodies of water at the facility. All cleaning solutions, poisons, and other dangerous chemicals are stored in an area inaccessible to children. LPA reminded the Director all unused electrical outlets need covers. All the bathrooms, toilets, and sinks are clean and well sanitized. All solid waste bins have a suitable tight-fitted lid on top, and the facility has a water fountain in the classroom readily available for children. The outdoor playground area is in good repair. The play structure is age-appropriate and in good condition, with sufficient cushioning underneath. Continued on page...2

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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: CITY OF SAN RAFAEL/VALLECITO SCHOOL AGE	FACILITY NUMBER: 210110892
	VISIT DATE: 08/19/2022

NARRATIVE

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The Director's and the childen's records were reviewed in today's inspection. All children had a medical assessment, and required licensing forms were completed. When children arrive, staff will sign in all children, and a head count will be conducted before entering the classroom. Multiple teachers have records of valid Pediatric FirstAid/CPR cards in the file and the required immunization. LPA also observed that the facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, and Notification of Personal Rights). The Director stated that Fire and Earthquake drills are done quarterly, and the last drills were conducted on 3/22/2022.

LPA reminded the Director that as of September 1, 2016. A person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles. LPA observed that the facility has a record of required immunization of all staff.

The 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

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.
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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: CITY OF SAN RAFAEL/VALLECITO SCHOOL AGE	FACILITY NUMBER: 210110892
	VISIT DATE: 08/19/2022

NARRATIVE

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The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to complete every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

LPA encouraged the Director to frequently visit the CCLD 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.

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.

During the inspection, LPA requested a new Emergency Disaster Plan (LIC 610), Designation of Responsibility (LIC 308), Personnel Report (LIC 500), Incidental Medical Services (IMS) Plan, and updated Mandated Reporter Training Certification. All requested documents will be submitted to Licensing by August 31, 2022.

No deficiencies were cited today. An exit interview was conducted, and the report was reviewed with the Director, Patricia Cerutti. Today's report, August 19, 2022, and notice of site visit were provided to the Director. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC809 (FAS) - (06/04)

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