210102903-8-29-2024-05-CC-JTSE-D8LSVZ-20240829141333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210102903
Report Date: 08/29/2024
Date Signed: 08/29/2024 02:13:55 PM

Document Has Been Signed on 08/29/2024 02:13 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	TAMALPAIS PRESCHOOL		FACILITY NUMBER:	210102903
ADMINISTRATOR/ DIRECTOR:	MARCELA AMADOR		FACILITY TYPE:	850
ADDRESS:	410 SYCAMORE AVENUE		TELEPHONE:	(415) 388-4286
CITY:	MILL VALLEY	STATE: CA	ZIP CODE:	94941
CAPACITY: 65	TOTAL ENROLLED CHILDREN: 62	CENSUS: 58	DATE:	08/29/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:50 AM
MET WITH:	Director, Marcela Amador		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

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	On 8/29/2024, at approximately 10:50AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Director Marcela Amador (D1) and explained the purpose of the visit. Present during the visit was D1, 12 teachers, and 58 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:00AM to 5:00PM, Monday to Friday. The facility is located on the premises of Mt. Tamalpais United Methodist Church. LPA and D1 inspected the facility for any health or safety hazards. LPA observed the facility to be in clean and orderly condition. There are fully charged 2A10BC fire extinguishers present in each classroom. There are carbon monoxide detectors that are operational. Emergency exits are clearly marked and visible. Evacuation routes and plans are available for review. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care. Electrical outlets are covered or obstructed by furniture to be inaccessible. There are heating and ventilation controls for the comfort and safety of children in care. Off-limits areas are kept inaccessible with childproof gates. The facility operates in three classrooms: Creek, Ocean, and Garden. LPA observed all classrooms to contain age-appropriate toys and learning materials. Furniture was observed to be age-appropriate and free of rough or sharp edges. There are cubbies available for each child in care that are labeled with their names. Per D1, children nap on mats that are cleaned as needed. Children bring bedding from home and take it back once a week for cleaning. Children bring lunch and water bottles from home. The facility provides AM/PM snacks for children in care. Water bottles are refilled as needed from a noncontaminating fixture. Children have access to operational toilets and handwashing sinks. LPA observed there to be six toilets and ten handwashing sinks available for children to use. LPA observed children’s allergies to be documented and medication to be stored in a central location. LPA discussed the storage of medication with D1 during the visit. Continued on Page Two

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TAMALPAIS PRESCHOOL	FACILITY NUMBER: 210102903
	VISIT DATE: 08/29/2024

NARRATIVE

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LPA observed the outdoor play areas to be free of debris and other loose articles. The Creek classroom has an outdoor play area that contains a sandbox, age-appropriate play structures and equipment, and mud kitchens/water play tables. The Ocean and Garden classrooms share an outdoor play area that contains a sandbox, age-appropriate play structures, and an outdoor learning space for science and building activities. Per D1, Ocean and Garden classes do not use the outdoor play area at the same time. LPA observed resilient padding in the form of woodchips. All outdoor play areas are enclosed by fences that are in good repair. Per D1, children are taken on walks outside the facility, but stay within the premises of the church. There are no pools or other similar bodies of water present in the facility.

LPA reviewed six staff files, ten children’s files, and facility records. LPA observed all staff to have current Pediatric First Aid/CPR training. D1 stated that a new training is scheduled for all staff in October. All staff members have current Mandated Reporter Training and qualifications on file. All children’s files were observed to include Emergency Identification and Information in addition to Consent for Emergency Medical Treatment. LPA observed all required postings to be posted and accessible for review.

Based on record review, the facility tested its fixtures for lead past the deadline of 1/1/2023. The facility tested its fixtures for lead and did not find any exceedances of lead. LPA informed D1 that a deficiency would be cited for untimely testing, however it would be cleared during the visit. The facility is now in compliance with lead testing requirements as of 8/29/2024. LPA advised D1 of the requirement to conduct lead testing every five years.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Continued on Page Three

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TAMALPAIS PRESCHOOL	FACILITY NUMBER: 210102903
	VISIT DATE: 08/29/2024

NARRATIVE

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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a
maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

See LIC809-D for deficiency cited and cleared today regarding lead water testing. See LIC9102-TA for technical assistance provided regarding storage of medications. Appeal rights were provided and explained to D1. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Marcela Amador.

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/29/2024 02:13 PM - It Cannot Be Edited

Created By: Jonathan Tse On 08/29/2024 at 01:54 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: TAMALPAIS PRESCHOOL	FACILITY NUMBER: 210102903
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by testing fixtures for lead after the deadline of 1/1/2023 which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/27/2024
	Plan of Correction
1 2 3 4	The facility tested its fixtures for lead and found no exceedances. This deficiency shall be cited and cleared on the day of the visit, 8/29/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Ali Zebila

LICENSING EVALUATOR NAME:

Jonathan Tse

LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC809 (FAS) - (06/04)

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