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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 213006109
Report Date: 09/17/2020
Date Signed: 09/18/2020 02:34:56 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:C.A.M.- MARIN HEAD START LYNWOOD (PS)FACILITY NUMBER:
213006109
ADMINISTRATOR:SHEILA CHAMBERSFACILITY TYPE:
850
ADDRESS:1320 LYNWOOD DRIVETELEPHONE:
(415) 883-3791
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:40CENSUS: 0DATE:
09/17/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Monique Liebhard & Robin PenceTIME COMPLETED:
02:00 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 Analyst (LPA) Haydee Caliboso met with Monique Liebhard and Robert Pence for an announced case management inspection. The facility requested to add classroom #10 to existing licensed childcare program. The facility is located in Lynwood Elementary School in Novato and will operate Monday - Friday; 8:00AM to 12:30PM. The designated site supervisor for the facility is Robin Pence.

LPA toured the proposed new classroom, which is set up for childcare. Existing listing areas, indoor and outdoor, were observed to be clean, safe, and free from hazards. New classroom was measured and inspected today for health and safety hazards. Indoor space measures 1005 square feet, allowing for a capacity of 12 children. See facility sketch and capacity worksheet in file. The requested additional classroom has a built-in, child-sized countertop with one sink and cabinets for storage. There is a total of 1 sink and 2 toilets accessible for children to use. The bathroom is clean and with no health and safety hazards. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children.

The following is required prior to licensure:
ยท Fire clearance approved by Novato Fire Department




No deficiencies were observed today. Notice of site visit was observed to be posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2020
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 1