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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005258
Report Date: 09/24/2019
Date Signed: 09/24/2019 05:39:08 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:MARIN DAY SCHOOLS - PARK SCHOOL CAMPUS EDSFACILITY NUMBER:
213005258
ADMINISTRATOR:PATRICIA WOODSFACILITY TYPE:
840
ADDRESS:360 EAST BLITHDALE AVENUETELEPHONE:
(415) 388-1458
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY:36CENSUS: 6DATE:
09/24/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Director, Patricia WoodsTIME COMPLETED:
05:50 PM
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Licensing Program Analyst, (LPA) Luis J. Gomez conducted a case management inspection today in response to an incident report received by licensing on September 12, 2019. Present is director and 1 staff supervising 6 children. The incident involved a 6-year-old child (C1) who, on September 3, 2019 at 4:20pm, had fallen off the playground slide, requiring immediate medical attention.

At 4:45pm on September 24, 2019 LPA Gomez inspected playground structure for health and safety hazards. LPA observed the play structure area has tanbark and padding for the children. Structure is in good repair and free of dangerous conditions.

At 4:55pm LPA interviewed with director and staff, and it was confirmed that the child (C1), had fallen from the structure injuring both arms, requiring medical attention. Director stated that she and staff responded to the incident immediately, notifying the child's parents. Director stated that “mother took child to urgent care, 10- 15 minutes after the incident”. The child return to the center the following day.

Director stated that On, September 4th, 2019, the site had a meeting with children and staff regarding safe practices while on the play yard and running outside. Director state, going forward she continue to advice staff to revaluate situations and stop activities when situations are unsafe or are hazardous.

After meeting with meeting with director and staff and inspecting of the physical plant, it was determined that the incident was handled in an appropriate and timely manner.

Exit interview was conducted and a Notice of Site Visit was given.

>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit was observed being posted. Licensee was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

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

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
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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