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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005379
Report Date: 01/10/2020
Date Signed: 01/10/2020 11:38:49 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:ANDREWSCAMPSFACILITY NUMBER:
214005379
ADMINISTRATOR:FRIERSON, ANDREWFACILITY TYPE:
840
ADDRESS:400 TAMAL PLAZA, #401ATELEPHONE:
(415) 446-8946
CITY:CORTE MADERASTATE: CAZIP CODE:
94925
CAPACITY:96CENSUS: 0DATE:
01/10/2020
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Andrew FriersonTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPAs), Farhan Bashir-Tariq and Kassandra Medrano met with Site Director, Andrew Frierson and Jonathan Gorton. Purpose of the inspection was explained and was for an Annual/Random Inspection. There were no children present at the time of inspection. LPAs verified the background check of the staff present today. Facility provides two snacks a day and menu were posted in the lobby area. Program operates M-F, 1:00 pm -7:00 pm.

LPAs inspected the facility indoors and outdoors for Health and Safety hazards. Classrooms have age appropriate toys and equipment that are in good repair. Cubbies are used to store Children’s belongings. Outdoor play area is free of debris and dangerous conditions. All outdoor toys and equipment are age appropriate and in good repair. Classrooms are equipped with multiple smoke and carbon monoxide detectors and fire extinguishers. Classrooms have proper ventilation and sufficient lighting. First Aid Kit and Emergency supplies are properly maintained and kept inaccessible to children. Cleaning products and toxins are maintained inaccessible to children. Drinking water is readily available indoors and outdoors. LPAs reviewed 8 random children's and 4 Staff files and are complete, including proof of immunization and Mandated Reporter Trainings. Director’s file was also reviewed. Multiple staff have valid CPR cards and Mandatory child abuse training certificates on files.

During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Facility was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Site Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Site Director was reminded about the Provider Information Notices (PINs) on CCLD website.
*Site Director was reminded about of Mandated Reporter Training available on CCLD website.

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

This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. 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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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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