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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005456
Report Date: 08/12/2021
Date Signed: 08/12/2021 03:35:46 PM

Document Has Been Signed on 08/12/2021 03:35 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:NORTH MARIN COMMUNITY SERVICES (SA)FACILITY NUMBER:
214005456
ADMINISTRATOR:CHERYL PADDACKFACILITY TYPE:
840
ADDRESS:680 WILSON AVETELEPHONE:
(415) 892-1643
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 168TOTAL ENROLLED CHILDREN: 0CENSUS: 44DATE:
08/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Ruthie ReederTIME COMPLETED:
10:37 AM
NARRATIVE
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Licensing Program Analyst (LPA) Haydee Caliboso met with the Site Supervisor Ruthie Reeder and Emily Bugos to conduct an unannounced annual inspection on 8/12/21. The purpose of the inspection was explained. Present during the inspection were 42 children and 4 staff, and 1 volunteer. Facility is operating within the capacity and is following staff child ratio. LPA observed that each classroom was operating within ratio on this day. The facility operates Monday – Friday, 7:00 AM to 6:00 PM. The Facility was inspected today, indoors and outdoors for health and safety hazards.

LPA observed no bodies of water at the facility. Per Site Supervisor there are no firearms or weapons in the facility. The facility is equipped with multiple smoke detector, carbon monoxide detectors, fully charged fire extinguishers and a working telephone available. The classrooms have adequate ventilation and ample lighting. All cleaning solutions, poisons and other chemicals that are dangerous to the children are stored made inaccessible to the children. The classrooms are equipped with age-appropriate toys and furniture. The furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. All toilets, hand washing facilities are in working condition with proper sanitation in place. All storage containers for solid waste and in good repair and have proper tight fitted lid on top. Facility has drinking water available for children for indoors and outdoors. During the inspection, LPA observed the playground is currently under construction. The playground is made inaccessible for children to used. First aid kit and emergency supplies are properly maintained and kept inaccessible to children. Site Supervisor stated that the facility currently does not have children who require medication or Incidental Medical Services.
Cont. 809 pg. 2
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2021
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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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: NORTH MARIN COMMUNITY SERVICES (SA)
FACILITY NUMBER: 214005456
VISIT DATE: 08/12/2021
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LPA reviewed personnel and children’s files during today’s inspection. LPA observed all files are complete and up-do-date. LPA observed facility has record of names, addresses and telephone numbers of each child 's authorized representative. Each child's record contains the record immunization. Multiple staff members have record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers. Facility has a log for emergency drills being conducted. Per log, last emergency drill was conducted on 6/9/21.

LPA reminded the Site Supervisor that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. The Site Supervisor was reminded about Mandated Reporter training available on the CCLD website. In addition to the AB1207 training that must be completed every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. LPA observed multiple staff have completed the child abuse training. Site Supervisor was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

LPA informed the Site Supervisor to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.


Cont. 809 pg. 3
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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: NORTH MARIN COMMUNITY SERVICES (SA)
FACILITY NUMBER: 214005456
VISIT DATE: 08/12/2021
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This report and rights to comment and appeal were discussed with Ruthie Reeder.
This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For rules and regulations, visit the website: www.cdss.ca.gov

The report was reviewed and signed by the Site Supervisor, Ruthie Reeder. Today’s report 8/12/21 and notice of site visit will be sent to the Site Supervisor by the end of the day on 8/12/21. Confirmation of receipt is required.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3