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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005477
Report Date: 08/18/2021
Date Signed: 08/19/2021 10:42:51 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:HUMMINGBIRDS COLLABORATIVE SCHOOLFACILITY NUMBER:
214005477
ADMINISTRATOR:RICHARD, MELINDAFACILITY TYPE:
850
ADDRESS:1990 NOVATO BLVD.TELEPHONE:
(415) 760-6197
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:42CENSUS: 0DATE:
08/18/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Melinda RichardTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Haydee Caliboso met with Melinda Richard (Director) for an announced case management inspection and for an increase in capacity to the existing licensed childcare program. The facility requested to add a new classroom called the “Lavender” classroom. The new classroom is built in a yurt tent. The facility will operate Monday - Friday; 7:30AM to 5:30PM. The designated Director for the facility is Melinda Richard.

LPA toured the proposed new classroom, which is set up for childcare. The new classroom was observed to clean, properly ventilated, with age appropriate toys available for children to use. Existing areas of the currently licensed program, indoor and outdoor, were observed to be safe, and free from hazards. New classroom was measured and inspected today for health and safety hazards. Lavender classroom was measured for 452.4 sq. ft t, allowing for a capacity of 12 children. See facility sketch and capacity worksheet in file. There are 3 sinks and 3 toilets located in the main classroom available for children to use. LPA reminded that active supervision and ratio must be observed at all times when children are present. The program will provide morning and afternoon snacks. Parents will provide lunch.

Based on today’s inspection LPA is granting the use of Lavender classroom for 12 children. The classroom will be added to the overall license.

No deficiencies were observed today. Notice of site visit was observed to be posted and shall remain posted for 30 days

The following requirements need to be submitted and further reviewed before a recommendation for licensure:

· Obtain fire clearance from Novato Fire Department
· Outdoor usage schedule
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
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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