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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004763
Report Date: 05/13/2021
Date Signed: 05/13/2021 11:51:24 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:CRAYON COLLEGE, INC.FACILITY NUMBER:
414004763
ADMINISTRATOR:MICHELLE MANGINIFACILITY TYPE:
850
ADDRESS:401 SANTA LUCIA AVENUETELEPHONE:
(650) 588-4197
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:48CENSUS: 0DATE:
05/13/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Michell Mangini & Elizabeth JepsenTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Glenn Schnell met with applicants Mangini and Jepsen today and conducted a follow-up pre-licensing inspection to evaluate corrections to the physical plant identified during the initial pre-licensing inspection on 2/26/21. LPA inspected the physical plant and observed all corrections needed have been completed.

LPA Schnell will recommend a provisional license for this facility effective 5/13/21 through 8/11/21. During the provisional licensure period, applicants agree to submit the follow application documents:
-MONTHLY OPERATING STATEMENT (LIC 401)
-EARTHQUAKE PREPAREDNESS CHECKLIST (LIC 9148)
-JOB DESCRIPTIONS
-PERSONNEL POLICIES
-IN-SERVICE TRAINING FOR STAFF
-PARENT HANDBOOK AND IMS PLAN
-DISCIPLINE POLICIES
-SCHEDULE OF DAILY ACTIVITIES
-SAMPLE MENU
-LIST OF FURNITURE AND/OR PLAY EQUIPMENT

Applicant was also reminded of the water testing for lead requirement and will have the water tested by January 2023.

Once the above items are received and verified for completeness, a regular license will be issuued.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
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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