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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213002658
Report Date: 04/29/2021
Date Signed: 05/10/2021 11:24:31 AM

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) HAMILTON (INF)FACILITY NUMBER:
213002658
ADMINISTRATOR:GRACE MORRISFACILITY TYPE:
830
ADDRESS:5520 NAVE DRIVETELEPHONE:
(415) 883-5318
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:16CENSUS: 14DATE:
04/29/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Kelsey Lombardi & Paula CifuentesTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Haydee Caliboso met with Kelsey Lombardi and Paula Cifuentes for an announced case management inspection. The facility requested to add classrooms (#9) and (#10) and an increase in capacity to the existing licensed childcare program. The program has requested a total capacity of 36 children.18 infants, ages birth to 24 months, and 18 toddlers, ages 24 to 36 months. The program will operate Monday - Friday; 7:30 AM to 6:00 PM. The designated site supervisor for the facility is Buntawan Vamnutjinda.

LPA toured the additional classroom, which is set up for childcare. Existing areas on the license, indoor and outdoor, were observed to be clean, safe, and free from hazards.

Indoor:
Classrooms (#9) and (#10) were measured to calculate capacity and the following square footage was calculated for each room: classroom (#9) 794 sq ft., allowing for a capacity of 20 children, and classroom (#10) 680 sq ft., allowing for a capacity of 20 children.

See facility sketch and capacity worksheet in file. The requested additional classrooms have a built-in counter-top with sinks and cabinets for storage. There is a total of 3 sinks and 4 toilets accessible for children to use. The bathrooms are clean and with no health or safety hazards. There are sinks for diaper changing tables within arm’s reach of the sink, and separate sink for food preparation. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children.
Cont.pg.2
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
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) HAMILTON (INF)
FACILITY NUMBER: 213002658
VISIT DATE: 04/29/2021
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LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 36 children once the following is received:

· Obtain fire clearance from Novato Fire Department

No deficiencies were observed today. Notice of site visit was observed to be posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC809 (FAS) - (06/04)
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