214005065-9-5-2019-05-CC-LGOZ-BFQUD3-20190905152853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005065
Report Date: 09/05/2019
Date Signed: 09/05/2019 03:28:58 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:	SRESD - BAHIA VISTA CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	214005065
ADMINISTRATOR:	MARISELA ESPINOSA PILAWSKI		FACILITY TYPE:	850
ADDRESS:	125 BAHIA WAY		TELEPHONE:	(415) 485-2415
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	15	CENSUS: 14	DATE:	09/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Director, Marisela Espinosa Palwski		TIME COMPLETED:	03:40 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, Luis J. Gomez met with Director Marisela Espinosa Pilawski. The purpose of the visit was explained and is for an annual inspection. This is a PreK program at Bahia Vista Elementary School. The Preschool operates during the school year and uses 1 classroom, (1C21) outdoor play area and garden. The program has two session: Mon- Fri, 8:00am- 11:00am and 12:00pm – 3:00pm. Present is the director and 2 staff supervising 14 children. Preschool is within capacity limits of the license. The Classroom, Outdoor Play Area and Garden were inspected for Health and Safety hazards. Classroom has age appropriate toys, wooden puzzles, blocks, books and equipment that are in good repair. Program utilizes a carpet area and play kitchen for the children. Classroom is equipped with storage cabinets, water fountain and plenty child size tables and chairs. Classrooms has acceptable ventilation and natural lighting. There is a working smoke detector, carbon monoxide detector and fully charged fire extinguisher (2A10BC) located in the hallway. A first aid kit is available and emergency disaster supplies are properly maintained and kept inaccessible to children. The facility has children's restroom located in the classroom. The children’s restroom is equipped with a toilet. Restroom is maintained clean, in good repair, and with adequate supplies for the children. Program utilizes an outdoor play area and garden. LPA Gomez inspected the outdoor play area and garden for safety hazards and dangerous conditions. LPA Gomez observed the outdoor play area is free of debris with a play structure and tan bark for padding. Drinking water is readily available with use of a water fountain. Director stated the school district provides all daily snacks and meals for children in care. All cleaning products and toxins are maintained inaccessible to children. Emergency drills are done monthly, with the last drill conducted on May 6, 2019, properly logged. Staff use a separate restroom located in the hallway. LPA Gomez observed all licensing information is properly posted in the front next to the main door. Continuation in page 2...

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

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: SRESD - BAHIA VISTA CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 214005065
	VISIT DATE: 09/05/2019

NARRATIVE

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LPA Gomez reviewed personnel files, facility roster and children's files during today's inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Site supervisor was informed about the Provider Information Notices (PINs) on CCLD website.

Based on today's inspection, No deficiencies were issued under Title 22 Division 12 of the Ca. Code of Regulations. An exit interview was conducted and a copy of this report was provided to Director Marisela Espinosa Pilawski, and her signature on this form acknowledges receipt of these documents.

Notice of Site Visit was provided Marisela Espinosa Pilawski

>This report and rights to comment and appeal were discussed with Site Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted.

Site Supervisor 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) 266-8832
LICENSING EVALUATOR NAME: Luis Gomez	TELEPHONE: (650) 393-9134
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

LIC809 (FAS) - (06/04)

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