214005019-2-19-2020-05-CC-CINO-BLXV35-20200219150409

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005019
Report Date: 02/19/2020
Date Signed: 02/19/2020 03:04:15 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 MARTIN LUTHER KING (PS)		FACILITY NUMBER:	214005019
ADMINISTRATOR:	ABUELQASEM, GAIDA		FACILITY TYPE:	850
ADDRESS:	610 DRAKE AVENUE		TELEPHONE:	(415) 339-9310
CITY:	MARIN CITY	STATE: CA	ZIP CODE:	94965
CAPACITY:	23	CENSUS: 7	DATE:	02/19/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Head Teacher, Gaida Abuelqasem		TIME COMPLETED:	02:20 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), Cindy Interiano conducted an Annual/Random inspection and met with Head Teacher, Gaida Abuelqasem. Purpose of the inspection was explained. Program operates M-F, 8:15a-4:15p following the School District Calendar. During School breaks, Program closes at 2:30p. Program operates on the Martin Luther King Elementary School Site in Bungalow/Portable 109. Present during the inspection is Head Teacher and a Staff supervising 7 PreK children. Program is in compliance with Staff:Child ratios and all Adults have criminal record clearance. LPA and Head Teacher inspected facility indoors and outdoors for Health and Safety Hazards. Classroom has age appropriate toys and equipment. Cubbies, hooks, and bins are used to store children’s belongings. Child’s restroom which has 2 toilets and 2 sinks. Additional sink is in the classroom. Restrooms are kept clean, in good repair and maintained with adequate supplies. Staff use separate restrooms, which is maintained off limits. Napping equipment is properly stored. Program provides daily snacks and meals, which are delivered daily from the C.A.M main kitchen. Facility has a fully supplied Emergency kit and emergency supplies, which are maintained inaccessible to children. Currently there are no children who have prescribed medications, however when they do, medications are maintained in the kitchen area and is kept with Guardian consent form, Doctor’s prescription and a log (when administered). Facility has a functioning telephone, is equipped with an industrial fire alarm system with Carbon monoxide detector, and a fire extinguisher. Last emergency disaster drill was conducted on 02/13/20 and is properly logged. Discipline policy is mainly redirection. Outdoor play area is free of debris and hazardous items and is completely fenced in. A daily sweep is conducted by staff of the outdoor play area prior to the children going out for outdoor play. All outdoor toys and equipment are age appropriate and in good repair. Drinking water is readily available outdoors and indoors. All mandatory postings are properly posted in each classroom. Sign in/out sheet was reviewed and was complete and up-to-date. Staff files were reviewed and is up to date and complete with Mandated Reporter training certificates, immunization and CPR expiring in 08/2020. See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 MARTIN LUTHER KING (PS)	FACILITY NUMBER: 214005019
	VISIT DATE: 02/19/2020

NARRATIVE

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During the inspection, Head Teacher was asked to remind Site Supervisor:
*about Incidental Medical Services (IMS) policy.
*about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*about Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*about Mandated Reporter Training available on CCLD website
(www.ccld.ca.gov or www.mandatedreporterca.com)
*about new Lead Bill (effective 01/01/19), requiring Facilities to distribute a two-page flyer to Guardians with information on lead poisoning facts
*about the Provider Information Notices (PINs) on CCLD website.

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

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

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

LIC809 (FAS) - (06/04)

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