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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213005570
Report Date: 06/23/2020
Date Signed: 06/23/2020 11:29:54 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:OLD FIREHOUSE SCHOOL MILL VALLEY-PRESCHOOLFACILITY NUMBER:
213005570
ADMINISTRATOR:ELIZABETH COHEN NOLASCOFACILITY TYPE:
850
ADDRESS:10 OLIVE STREETTELEPHONE:
(415) 388-1417
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY:40CENSUS: 3DATE:
06/23/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director, Elizabeth Cohen-NolascoTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Kassandra Medrano conducted an announced facility tele-inspection via WhatsApp due COVID-19 and met with Director, Elizabeth Cohen-Nolasco.The purpose of the inspection was to discuss an unusual incident that that was reported on May 22, 2020. During the inspection, there were 3 children, with 3 staff. Meeting child-teacher ratio requirements. Facility is awaiting more information on the incident. A follow-up inspection may be conducted.

No deficiencies were issued today under Title 22, Division 12 of the California Code of Regulations




This report and notice of site visit were discussed with the director and must be made available to the public upon request.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020
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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