414001376-3-5-2020-05-CC-AMEN-BMEQ4K-20200305105029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001376
Report Date: 03/05/2020
Date Signed: 03/05/2020 10:50:34 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:	SSFUSD MARTIN CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	414001376
ADMINISTRATOR:	NICOLE FISHER		FACILITY TYPE:	850
ADDRESS:	35 SCHOOL STREET		TELEPHONE:	(650) 827-2812
CITY:	SOUTH SAN FRANCISCO	STATE: CA	ZIP CODE:	94080
CAPACITY:	23	CENSUS:	DATE:	03/05/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Lisa Ferrari		TIME COMPLETED:	10:55 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Andrea Medlin met with director for this case management licensing visit. Purpose of visit is due to a temporary room change while current classroom (#13) is renovated. Facility is temporarily operating in portable #26 on the campus of Martin Elementary School. Facility operates two sessions: 8:30AM-11:30AM and 12:00PM-3:00PM. Physical plant toured to inspect for health and safety hazards. There is a fully charged fire extinguisher that meet minimum requirements, smoke detector, and a carbon monoxide (CO) detector in the facility. Children's bathroom inspected; all toilets and hand washing facilities are in safe and sanitary operating condition. A separate staff bathroom is available. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per director, there are no firearms or weapons on site. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible. Variety of age appropriate toys and materials for children are available. Classroom is set up for child care and furniture and equipment for children is present. Snacks are provided. Adequate first aid supplies are available. Sick children will be separated from the group while waiting for parents to pick up. Facility uses designated "kindergarten" outdoor playground and has exclusive use during scheduled times. Outdoor play area inspected for health and safety hazards. The areas around and under high climbing equipment is cushioned with soft rubber. Outdoor activity space is enclosed by fences and surfaces are free of hazards. Facility has posted all the required licensing forms in the classroom. (Continued on next page 809-C)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

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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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: SSFUSD MARTIN CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 414001376
	VISIT DATE: 03/05/2020

NARRATIVE

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The following is received during the visit:

Approved fire clearance for Martin Elementary School
Updated LIC 200A - Application for Child Care Center License (with revisions to capacity)

Temporary classroom change is approved for use for the preschool program.

This report is reviewed with director and a copy of this report must be made be available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

LIC809 (FAS) - (06/04)

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