<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213003960
Report Date: 08/07/2019
Date Signed: 08/07/2019 12:01:38 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 - PARKSIDE CHILDREN'S CENTERFACILITY NUMBER:
213003960
ADMINISTRATOR:MCGRATH, KELLYFACILITY TYPE:
850
ADDRESS:51 ALBERT PARK LANETELEPHONE:
(415) 485-3387
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY:90CENSUS: 41DATE:
08/07/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Administrator, Kelly AlbrechtTIME COMPLETED:
12:10 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
Licensing Program Analysts, Luis J. Gomez Administrator Kelly Albrecht. The purpose of the visit was explained to director and is for an annual inspection. This is a combination center with a PreK program on site. The School-Age program operates year-round and uses 4 rooms (Front Room, Multipurpose Room, Recreation Room and Study Room) and an outdoor play yard. During the summer session, the hours of operation are: Monday- Friday 7:30am- 6:00pm. During the school year, the hours of operation are: Monday- Friday 3:45pm- 6:30pm except on Wednesday’s; 1:45pm- 6:30pm. Present is site administrator and 4 staff supervising 33 children. After inspection, 41 children were present at the facility. Facility was inspected indoors and outdoors for Health and Safety hazards. All classrooms have age appropriate puzzles, games, building blocks, books and equipment that are in good repair. Classrooms have acceptable ventilation and ample lighting. The facility is equipped with a smoke detector and fully charged fire extinguisher (3A10BC). Carbon monoxide detector is located in the kitchen. First Aid Kit is fully stocked. Emergency supplies are properly maintained and kept inaccessible to children. All cleaning products and toxins are maintained inaccessible to children, locked in a closet next to the children’s restroom. Facility has 2 restrooms (Girls and Boys). Restrooms are maintained clean, in good repair, and with adequate supplies. Staff use a separate restroom located outside the office. Each restroom is equipped with 3 toilets and share an hand washing station. Facility kitchen is inaccessible to children by a locked children’s gate. Emergency drills are done monthly, with the last drill conducted on 05/08/2019 properly logged in. LPA Gomez inspected outdoor play area for safety hazards and dangerous conditions. The school-age program utilizes an outdoor play area. The play yard is completely fenced. LPA Gomez observed play area is equipped with a climbing structure and tether ball court. Drinking water is readily available indoors and outdoors for daycare children. LPA Gomez inspected the children’s medication and observed all medication is current. Program provides a daily morning and afternoon snack. Director stated that the children bring their own lunches during the summer. All required licensing information is properly posted in the front next to the main door.

Continue to page 2...

SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
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 - PARKSIDE CHILDREN'S CENTER
FACILITY NUMBER: 213003960
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited
HSC
1596.7995
1
2
3
4
5
6
7
1596.7995 Employee or Volunteer at Day Care Center; Immunization Requirements; Records; Exemptions. The day center shall maintain documentation of required immunization or exemptions from immunization, as set fourth in this section, in the person's personnel record that is maintained by the daycare.
1
2
3
4
5
6
7
Administrator will submit proof of employee immunization by the due date: 8/28/2019

Administrator will submit proof of correction licensing.
8
9
10
11
12
13
14
This requirement is not met as evidenced by; LPA Gomez observed the proof of immunization's was missing from 3 personnel files. This is a potential health and safety risk to children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
Page: 3 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 - PARKSIDE CHILDREN'S CENTER
FACILITY NUMBER: 213003960
VISIT DATE: 08/07/2019
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
26
27
28
29
30
31
32
Page 2. . . During today's inspection, LPA Gomez review Personnel files, Children's files and Facility Roster. LPA Gomez observed the proof of immunization's was missing from 3 personnel files. Staff's CPR/ 1st aid is current expiring 2/2021.

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


Site Supervisor was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Site supervisor was informed about the Provider Information Notices (PINs) on CCLD website.

Site Supervisor was reminded to make sure all staff have Mandated Reporter Training certificate on file.

>See attached deficiencies page for deficiencies issued today under Title 22 Division 12 of the Ca. Code of Regulations.

This report and a Notice of Site Visit are provided to Site Director

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.


Site Supervisor was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3