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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005539
Report Date: 03/26/2021
Date Signed: 04/13/2021 10:09:26 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:SAUSALITO MARIN CITY SCHOOL DISTRICTFACILITY NUMBER:
214005539
ADMINISTRATOR:GARCIA, ITOCOFACILITY TYPE:
840
ADDRESS:200 PHILLIPS DR.TELEPHONE:
(415) 332-3190
CITY:MARIN CITYSTATE: CAZIP CODE:
94965
CAPACITY:120CENSUS: 0DATE:
03/26/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Itoco Garcia, Cameron Taylor, Robert ClarkTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Haydee Caliboso met with Superintendent Itoco Garcia today for a pre-licensing inspection. Today’s inspection included COVID-19 technical assistance, guidance, and support. This facility is located on a functioning elementary school site of Sausalito Marin City School District. The applicant has requested a capacity of 120 children ages 5 to 12 years old. The facility will operate Monday – Friday, 8:00 AM to 9:00 AM and from 3:00 PM to 6:00 PM. The designated director for the facility is Itoco Garcia until the program hires a qualified director/site supervisor. The facility was inspected today, indoor and outdoor, for health and safety hazards.

Indoor:
The school-age program is exempt from requirements for indoor and outdoor space square footage, fencing, toilet/sink ratios, and isolation of sick requirements. No measurements were taken today. Portable classrooms (Rooms 104-111) and non-portable classrooms (Rooms 202-204) were inspected today. Classrooms located on the second floor (Rooms 202-204) of the main building, as well as the school library and cafeteria, were observed today to be clean. The school furniture and equipment are safe and in good working condition. There is storage space for children's personal belongings located outside of the classrooms. The school is equipped with a fire alarm system and carbon monoxide detectors. All food and snacks are prepared in the school cafeteria. The school will provide breakfast and afternoon snacks daily prepared by staff on-site. The program is only using disposable products for mealtimes during the COVID-19 pandemic.
Cont. 809 pg.2
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: SAUSALITO MARIN CITY SCHOOL DISTRICT
FACILITY NUMBER: 214005539
VISIT DATE: 03/26/2021
NARRATIVE
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Water will be provided to the children by use of water fountains, pitchers of water, and personal water bottles provided by the school. Each room has garbage cans with tight-fitting lids. First-aid, medications, and emergency supplies are located at the Nurse’s office. The facility is adequately ventilated and free of insects and bugs.

Sign-in/Sign-out: Sign-in will be completed by staff. Sign-out during pick-up will be completed by parents and authorized guardians. The bathrooms were observed to be clean and with no health or safety hazards. All toxins and other hazardous items will be stored in a locked cabinet and made inaccessible to children. There are designated bathrooms available to use for both genders. The bathrooms have individual privacy for each child.

Outdoor:
The entire outdoor area of the school is enclosed by a fence that is at least four feet tall. The playground is observed to be clean, safe, and equipped with climbing structures that are appropriate for children’s age-group. Artificial turf material is used for cushioning under climbing structures. The outdoor space will be used only by children attending the elementary school. The applicant will ensure close and active supervision of the children. There will be no commingling of children from the elementary school and outside the community during the hours before and after the school program. Personal bottled water, pitchers of water with disposable cups, and water fountains will be used for outdoor activities.

The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, Care and Supervision of the Children, Child Discipline Procedures-talking and redirection, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Food Service, Transportation-none provided, Parents Rights, Reporting Requirements, and Sign in/Sign out procedures.

Cont. 809 pg.3
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SAUSALITO MARIN CITY SCHOOL DISTRICT
FACILITY NUMBER: 214005539
VISIT DATE: 03/26/2021
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The facility will conduct monthly disaster drills and a log will be maintained for review upon request. Information was provided to applicants during today's inspection. This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 120 school age children once the following is received:

· Obtain fire clearance from Marin Fire Department
· Lead Poisoning Prevention Certificate
· COVID-19 Self-Assessment Guide
· Letter from School Superintendent for approval and state capacity for each classroom.

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) -26-8864
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3