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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005161
Report Date: 09/19/2019
Date Signed: 09/19/2019 11:50:34 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:UNIVERSITY OF PLAYFACILITY NUMBER:
213005161
ADMINISTRATOR:STOWELL, SYLVIAFACILITY TYPE:
850
ADDRESS:1055 LAS OVEJAS AVE RM#4TELEPHONE:
(415) 499-0309
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:30CENSUS: 27DATE:
09/19/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Director, Sylvia Ballenger TIME COMPLETED:
12:00 PM
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Licensing Program Analyst, (LPA) Luis J. Gomez met with director Sylvia Ballenger for this plan of correction inspection. Present is director and 6 staff supervising 27 children. All children present are Preschool age. LPA toured the facility for health and safety hazards. LPA reviewed the following deficiencies issued on March 14, 2019:

101229 (a)Responsibility for Providing Care and Supervision.

101223(a)(3) Personal Rights.

During today's inspection, Director submitted training attendance sheets and materials from staff training. Director stated she is working with San Rafael Fire Department to modify the newly installed double gate.

Deficiency issued on March 14, 2019 have been cleared. 'Cleared POC Letter' was given to Licensee.

**No deficiencies were cited against the facility today under CCR,Title 22, Div. 12, Chapt. 1**

This report and rights to comment and appeal were discussed with Licensee. This report must be kept in the facility available for public review. Notice of site visit was observed being posted.

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

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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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