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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410505762
Report Date: 01/26/2023
Date Signed: 01/26/2023 02:06:26 PM


Document Has Been Signed on 01/26/2023 02:06 PM - It Cannot Be Edited

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:INTERCOMMUNAL SURVIVAL SCHOOLFACILITY NUMBER:
410505762
ADMINISTRATOR:CAMACHO, MELINDA ANNFACILITY TYPE:
850
ADDRESS:713 SECOND AVENUETELEPHONE:
(650) 347-0463
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:29CENSUS: 18DATE:
01/26/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Melinda CamachoTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted a scheduled case management visit and met with Director Melinda "Mindy" Camacho. Present at the facility were the Director, four teachers, and 18 preschool aged children. LPA was asked to remeasure the rooms on the main floor of the school. The school's basement classroom is temporarily closed due to flooding from recent storms and having to repair the damaged flooring of the classroom. Deer classroom has relocated to the main floor of the facility temporarily until repairs are complete.

LPA remeasured classrooms on the main level of the school to ensure the school could fit all the children. Director stated that there are currently seven children enrolled in the Deer classroom and 12 enrolled in the Blue Jay classroom but not all 19 children attend school each day. Classrooms alternate between an outdoor and an indoor classroom setting weather permitting. Children are all together on the main floor of the school during meals and nap time.

LPA measured the rooms on the main level of the school for a total of 632.78 sq ft divided by 35 sq ft for a total capacity of 18 children. Director will ensure there will only be a total of 18 children at the school on any given day and a schedule will be created to alternate the children's attendance if all 19 children arrive at the school. Director will notify LPA once the basement classroom repairs have been completed so LPA can inspect the room for health and safety hazards prior to the Deer classroom utilizing the room again.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Exit interview conducted and report was reviewed with Director Mindy Camacho. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Daniel J OquendoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
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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