214005379-8-27-2021-05-CC-KMEO-C6ATYM-20210827150859

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005379
Report Date: 08/27/2021
Date Signed: 08/27/2021 03:09:55 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:	ANDREWSCAMPS		FACILITY NUMBER:	214005379
ADMINISTRATOR:	GORTON,JONATHAN		FACILITY TYPE:	840
ADDRESS:	400 TAMAL PLAZA, #401A		TELEPHONE:	(415) 446-8946
CITY:	CORTE MADERA	STATE: CA	ZIP CODE:	94925
CAPACITY:	96	CENSUS: 3	DATE:	08/27/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Director, Jonathan Gorton		TIME COMPLETED:	03:15 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	On August 27th, 2021, at 2 pm Licensing Program Analyst (LPA) Kasssandra Medrano met with Director, Jonathon Gorton. The purpose of the visit was explained. An annual inspection was conducted today. Facility is located on a private site, and is two floors, children have access to both floors. LPA inspected the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. At 2:15PM during review of staff files, LPA observed that staff present did not have units needed. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The program operates 1:30pm-6pm, Monday- Friday. The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures (smoke and carbon monoxide detectors present and in working order), Medication Policies, Isolation of Sick Children, Food Service, Transportation, Parents Rights, and Reporting Requirements. The outdoor play area is located out front and is identified as "front lawn". Children are signed in to the facility by facility and out of the facility by parent or guardian. Posting requirements for site visits were discussed as well as AB 633 requirements. Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov. Staff immunization are on file. Director was reminded that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Influenza Declarations were also reviewed. For More information about changes to the Healthy Schools Act, templates, or articles, you can inspect the DPR website at: https://apps.cdpr.ca.gov/schoolipm/childcare/training/main.cfm . Director was informed about the Provider Information Notices (PINs) on CCLD website.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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: ANDREWSCAMPS	FACILITY NUMBER: 214005379
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/27/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/24/2021 Section Cited	1 2 3 4 5 6 7	101516.2(a)(b) School-Age Child Care Teacher Qual. &Duties (a)In addition to Section 101216.1, the following shall apply: (b) As an alternative educational prerequisite, a school-age child care teacher may, pursuant to HSC Section 1597.21, substitute 20 training hours for each of the required units of education in Section 101216.1. Units and training hours may be combined to meet the total educational requirement (12 units or 240 training hours, or any combination thereof).
	8 9 10 11 12 13 14	At 2:13 During review of 4 staff files, LPA observed that staff were short or did not have units. Director stated that he was not aware that staff needed 12 units. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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: ANDREWSCAMPS	FACILITY NUMBER: 214005379
	VISIT DATE: 08/27/2021

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Director was reminded of Mandated Reporter Training available on CCLD website. Training must be renewed every two years. Incidental Medical Services (IMS) policy was discussed.This facility provides IMS. A review of storage of medications, equipment and supplies, and reviewed children, personnel and administrative records.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):

"NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

LIC809 (FAS) - (06/04)

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