213001036-12-18-2019-05-CC-FBTQ-BJRUKX-20191211143948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 213001036
Report Date: 12/11/2019
Date Signed: 12/18/2019 05:45:14 PM

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 - PICKLEWEED P/S		FACILITY NUMBER:	213001036
ADMINISTRATOR:	SHAW, ISOBEL		FACILITY TYPE:	850
ADDRESS:	40 CANAL STREET		TELEPHONE:	(415) 485-3101
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	44	CENSUS: 36	DATE:	12/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Kelly McGrath		TIME COMPLETED:	02:50 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	** This report is an amendment of original report issued on 12/11/19.** Licensing Program Analyst (LPA) Farhan Bashir-Tariq met with Program Director, Kelly McGrath (S1), to conduct an Annual Inspection on 12/11/19. Purpose of the inspection was explained. Present, there were 36 children in care with 5 teachers. Facility is operating within the capacity and is following staff child ratio on this day. Facility provides two snacks and menus for the snacks were posted in each classroom. Facility is currently in the process of hiring a new director. LPA inspected the facility for health and safety hazards. LPA inspected Room 1, Room 2 and Room 3 and verified the background check clearance of the staff present today in each room. LPA observed each classroom was complying to the child and staff ratio. Per S1, there are no pools, spas or other bodies of water at the facility. Facility has multiple smoke detectors, carbon monoxide detectors, and fully charged fire extinguishers installed in each classroom. A working telephone is also available at the site. Facility has sinks in each classroom and chemicals are stored in the cabinets under sink. All cabinets with chemicals have been blocked off with a child safety lock. Facility has age appropriate furniture. Furniture is steady and in good repair. 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 lids on top. Facility has drinking water available for children. All the materials and surfaces accessible to the children in care appear to be clean. Play yard is free of hazards. All of the play structures are steady, in good repair and free of any loose parts. All children have their own individual cubby for their personal belongings in each classroom. Each classroom is furnished with age appropriate toys, books, furniture, learning equipment, and first aid supplies. LPA reviewed the facility records. LPA reviewed 8 random children's and all present staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Each child's record contains the record immunization. One or more staff members present today have record of valid CPR card in file. LPAs reviewed the educational qualification of all the teachers. Facility has a log for emergency drills being conducted. Per log, last emergency drill was conducted on November 4, 2019 in room 4 and September 29, 2019 in room 3. Facility conducts separate fire drills for each classroom due to the difference in hours of operation for programs. Continuation on next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 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: CITY OF SAN RAFAEL - PICKLEWEED P/S	FACILITY NUMBER: 213001036
	VISIT DATE: 12/11/2019

NARRATIVE

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**** This report is an amendment of original report issued on 12/11/19.****
Facility does not provide medication to the children enrolled at present. 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

Facility was reminded that All adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CDL or CA. ID prior to having any contact with children in care failure to do so could result in an immediate civil penalty.

Facility was reminded, As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the training completion certificates for two of the teachers present today. LPA encouraged the facility 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.

This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. Facility was advised any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

Page: 2 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: CITY OF SAN RAFAEL - PICKLEWEED P/S	FACILITY NUMBER: 213001036
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/11/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/12/2019 Section Cited	1 2 3 4 5 6 7	** This report is an amendment of original report issued on 12/11/19. Citation has been removed.**
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3