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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005020
Report Date: 08/27/2020
Date Signed: 08/31/2020 09:52:57 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:C.A.M.- MARIN HEAD START MEADOW PARK (INF)FACILITY NUMBER:
214005020
ADMINISTRATOR:ALISON BURNSFACILITY TYPE:
830
ADDRESS:5 HUTCHINS WAYTELEPHONE:
(415) 884-2004
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:16CENSUS: 9DATE:
08/27/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Carol Lang TIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Haydee Caliboso and Farhan Bashir -Tariq met with Carol Lang for an announced case management inspection. The facility requested increase of capacity from 16 to 20.

LPAs toured the facility, which is set up for child-care. Present during today’s inspection was nine children and six teachers. Existing areas on the licenses, indoor and outdoor, were observed to be clean, safe and free from hazards. The classrooms were measured and inspected today for health and safety hazards. Total indoor space measures 1198 square feet allowing for a capacity of 20 children. See facility sketch and capacity worksheet in file. Existing classroom #1 has 1 toilet and 2 sinks. Classroom #2 has 1 toilet and 2 sinks. There is a total of 4 sinks and 2 toilets for children to use. Isolation area for ill child will be the two offices, one in each classroom. Fire clearance for a capacity of 20 has been received already from Novato Fire Department.

An electronic copy of this report was emailed to applicant Carol Lang. Applicant was asked to review the report and return a signed copy of the report to LPA Haydee Caliboso

LPAs Haydee Caliboso and Farhan Bashir – Tariq will recommend licensure of this facility for a capacity of 20 children.

No deficiencies were observed today. This report must be available in the facility for public review. Facility was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2020
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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