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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005499
Report Date: 08/16/2019
Date Signed: 08/16/2019 10:48:17 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:MARIN YMCA AFP AT WADE THOMAS ELEMENTARY SCHOOLFACILITY NUMBER:
214005499
ADMINISTRATOR:KELLEY, TORREYFACILITY TYPE:
840
ADDRESS:150 ROSS AVENUETELEPHONE:
(415) 452-7582
CITY:SAN ANSELMOSTATE: CAZIP CODE:
94960
CAPACITY:100CENSUS: DATE:
08/16/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:TIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Pandora Huffman-Smith made a follow up pre-licensing inspection today and met with the director of youth development (Jordan James), site coordinator (Katrina Riddle), and associate director of youth development (Marissa Williams). The purpose of today's visit is to inspect the classrooms that were unavailable to be inspected during the initial pre-licensing. The program will operate on the functioning school site of Wade Elementary School in classrooms 8, 16 and the multi-purpose room. The classrooms were inspected today and the following was observed; Classroom #8 will be the main area for the program and is equipped with a fire extinguisher, carbon monoxide detector, first aid kit and emergency supplies. The program also has access to the elementary school's emergency supplies. Classroom #16 will be used as an overflow .

No apparent health and safety hazards were observed during today's inspection.

Prior to licensure:
  • Proof of fire clearance is required.
  • The program requires a smoke detector to be installed.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Pandora Huffman-SmithTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
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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