213006108-4-27-2023-05-CC-HLEG-CRAPF5-20230427111609

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 213006108
Report Date: 04/27/2023
Date Signed: 04/27/2023 11:16:15 AM

Document Has Been Signed on 04/27/2023 11:16 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	C.A.M. (CFS) SAN PEDRO (PS)		FACILITY NUMBER:	213006108
ADMINISTRATOR:	LOMBARDI, KELSEY		FACILITY TYPE:	850
ADDRESS:	498 POINT SAN PEDRO ROAD		TELEPHONE:	(415) 485-2450
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	40	CENSUS: 0	DATE:	04/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Ashley Girdler		TIME COMPLETED:	11:30 AM

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On 4/27/2023, Licensing Program Analyst (LPA), Hanson Leong, made an unannounced annual visit to the C.A.M San Pedro Preschool facility. The LPA was granted entry by the Lead Teacher, Ashley Girdler. The LPA explained the purpose of the visit to Ms. Girdler. All the individuals listed on the facility’s roster have been granted permission to work or be present in a childcare facility. There were no children or staff present at the time of the visit. According to Ms. Girdler, the facility has been closed since 3/1/2023 due to a sewer issue in the facility.

LPA performed comprehensive inspections of the facility to look for possible threats to health and safety. The facility offers a first aid kit that is completely loaded with everything that is required for the treatment of wounds and other types of injuries. Toys, furnishings, and learning materials in all classes are age appropriate. The LPA observed that the playground equipment and outdoor furnishings are in very good shape. The LPA found that the facility did not have any pools, spas, or other types of bodies of water of any kind. All poisons, cleaning products, and other potentially harmful substances have been stored in a location that is inaccessible to children. The building is equipped with smoke detectors, carbon monoxide detectors, fire extinguishers that are properly charged, centralized smoke alarms, and phones that are in working order.

Ms. Girdler has stated that the facility does not house any firearms or other types of weapons.

The LPA observed that the facility posted the required documents. (i.e., license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities).

Since the facility was closed for maintenance, staff and children's files were not reviewed at this time.

The following reminders were discussed with Ms. Girdler:

1. All adults 18 and over living or working in a licensed childcare facility, including employees and volunteers, *** See Page 2 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: C.A.M. (CFS) SAN PEDRO (PS)	FACILITY NUMBER: 213006108
	VISIT DATE: 04/27/2023

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Continued, Page 2
must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed childcare facility.
2. Incidental Medical Services (IMS) policy
3. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

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

A copy of this report, and the “Notice of Site Visit, “were given to Ashley Girdler

A “Notice of Site Visit” must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Ashley Girdler

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

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