214005607-3-30-2022-05-CC-CQUO-CCZU4L-20220330151516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005607
Report Date: 03/30/2022
Date Signed: 03/30/2022 03:16:17 PM

Document Has Been Signed on 03/30/2022 03:16 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:	OLD FIREHOUSE SCHOOL		FACILITY NUMBER:	214005607
ADMINISTRATOR:	COHEN, ELIZABETH		FACILITY TYPE:	850
ADDRESS:	1510 FIFTH AVENUE		TELEPHONE:	(925) 284-4321
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/30/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Dorothy Stewart & Elizabeth Cohen		TIME COMPLETED:	03:30 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 March 30, 2022 at 10:00am, Licensing Program Analyst (LPA) Catrina Quimbo met with applicant, Dorothy Stewart, and center director, Elizabeth Cohen, for a pre-licensing inspection. The applicant is requesting for a combination center of a preschool license and an infant license. Under the preschool license, the applicant is requesting 12 children (2 years to entry into first grade). Under the infant license, the applicant is requesting 8 children (ages birth to 24 months). The facility will operate Monday through Friday from 8:00am to 5:30pm. Children will be signed in and out with an electronic signature. The designated director for the facility will be Elizabeth Cohen. The facility will operate as a Spanish immersion program. The facility was inspected, indoors and outdoors, for health and safety hazards and measured to calculate capacity. Indoors: There are two classrooms that will be used for the preschool program. Preschool classroom #1 was calculated for 547 sq ft. allowing for a capacity of 15 children. Preschool classroom #2 was calculated for 374.68 sq ft. allowing for a capacity of 10 children. Total allowable capacity was calculated for 921.68 sq ft. allowing for a capacity of 26 children. The bathroom accessible to preschool children is a shared bathroom located between the classrooms. Bathroom includes 1 toilet and 1 sink for children's use. Total allowable capacity for toilets and sinks is 15 children. Both classrooms also have 1 additional adult sink and 1 accessible children's sink. All sinks accessible to children do not provide water that is warmer than 120 degrees. Garbage cans have tight fitting lids. (Continue Report on Page 2...)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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: OLD FIREHOUSE SCHOOL	FACILITY NUMBER: 214005607
	VISIT DATE: 03/30/2022

NARRATIVE

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The classrooms used for the preschool program was observed to be clean and equipped with a fully charged fire extinguisher and carbon monoxide detector. Facility maintains a fire alarm system. All furnishing, toys and equipment was observed to be safe, age appropriate and in good condition. Sufficient storage space for children's personal belongings is located inside the classroom. Cots and mats are to be utilized for napping children. Program will provide sheets that will be laundered weekly on site or as needed.

The facility is adequately ventilated and free of insects and bugs. First Aid Kits and emergency supplies are located inside each classroom, inaccessible to children. Cleaning products will be stored in classroom's high cabinets or off limit areas, inaccessible to children.

The facility also contains multiple staff lounges for staff purposes only. Each classroom has a separate food prep area that is equipped with a refrigerator, sink, and dishwasher. Food prep areas are to be off limits to children. Program will provide dry morning and after snacks only. Lunch is to be provided by enrolled children's families. LPA reminded applicant children who bring their own items are to be labeled with each child's individual names. Facility will require children to provide their own individually, labeled water containers that will be refilled at the facility. Water is available to children both indoors and outdoors. LPA reminded applicant cleaning products and other chemicals are not to be stored with food. Isolation area will be located in facility office.

Medications with children’s individual names and required documentation will be stored in classroom’s high cabinets in off limit area. Medications that require refrigeration will be stored in prep area's refrigerator. This facility plans to provide Incidental Medical Services –
IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation
that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information
Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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: OLD FIREHOUSE SCHOOL	FACILITY NUMBER: 214005607
	VISIT DATE: 03/30/2022

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Outdoor: The outdoor area measures 1,341.967 sq ft allowing for a capacity of 17 children. Entire outdoor area is enclosed with an at least 4ft high fence. Outdoor area was observed to be clean. Adequate shade is provided by trees surrounding the area. Outdoor area also include multi-purpose alley/walkway located next to the facility. Multi-purpose area was calculated for 681.18 sq ft allowing for a capacity of 9 children. Due to the multi-purpose area's location and not used on an everyday basis, square footage is not applied for overall outdoor capacity.

LPA reminded applicant and center director to conduct and document emergency disaster drills at least once every six months. Applicant was reminded infant and preschool children cannot co-mingle at any time.

Applicant and center director were reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant and center director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant and director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed with center director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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: OLD FIREHOUSE SCHOOL	FACILITY NUMBER: 214005607
	VISIT DATE: 03/30/2022

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Prior to recommended licensure, applicant must complete following:
-Updated Proof of control of property
-Release of financial verification
-Fire clearance for facility
-Director packet finalized for Fac # 213005570
-Waiver Request for shared preschool bathroom
-Door sensor alarm installations on exit doors in classrooms.
-Installation of child safety lock on cabinet in Preschool classroom #1.
-Removal of cement blocks in outdoor area
-Covering of pot holes in outdoor area.
-Installation of resilient padding in outdoor area.

Exit interview conducted and report was reviewed with applicant, Dorothy Stewart, and center director, Elizabeth Cohen.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC809 (FAS) - (06/04)

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