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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005499
Report Date: 07/26/2019
Date Signed: 08/02/2019 10:34:49 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: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:
07/26/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jordan JamesTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Pandora Huffman-Smith made a 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 applicant is requesting 100 school age children. The program will operate on the functioning school site of Wade Elementary School in classrooms 8, 16 and the multi-purpose room. Days and hours of operation will be Monday - Friday from 7:00 AM to 9:00 AM and 1:30 PM to 6:30 PM. The facility was inspected today, indoor and outdoor, for health and safety hazards.

Indoor: The multi-purpose room appears to be clean and free of health and safety risks. Classrooms 8 and 16 are not set up for usage during today's inspection and a follow-up inspection will be required. There are 4 bathrooms for children's usage; 2 gender neutral bathrooms that are equipped with one toilet and one sink in each and 2 larger bathrooms with multiple toilets and sinks in each. The larger bathrooms were inaccessible during the inspection and will be inspected during the follow-up inspection.

Outdoor: The outdoor area appears to be clean, safe and there is sufficient cushioning underneath all play structures.

A follow up inspection is scheduled for August 16, 2019.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Pandora Huffman-SmithTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019
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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