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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005680
Report Date: 07/02/2024
Date Signed: 07/02/2024 02:53:43 PM

Document Has Been Signed on 07/02/2024 02:53 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:OLD FIREHOUSE SCHOOLFACILITY NUMBER:
214005680
ADMINISTRATOR/
DIRECTOR:		SUSAN BRITSONFACILITY TYPE:
860
ADDRESS:10 BAYVIEW DRIVETELEPHONE:
(925) 284-4321
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: DATE:
07/02/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Applicant Dorothy StewartTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Jamel Maiwandi and Licensing Program Manager Mai Lor (LPM) met with Applicant Dorothy Stewart and Director Susan Britson for the purpose of an announced pre-licensing inspection at 10 Bayview Drive, San Rafael, CA 94901. Also present during this inspection are Wildlife Preschool Teacher, Jackie Buhl, Co-Owner, Bob Buhl, Preschool Teacher Kristen Wrench. Applicant requests a preschool component to serve 54 children from age two years to entry into first grade. The program will operate Monday through Friday from 8:00 a.m. to 5:30 p.m. The facility will be providing morning and afternoon snacks, and parents will be responsible for lunches. The fire clearance (STD850) was granted on 4/2/2024, however the fire clearance has an E occupancy code. LPA is awaiting response from fire inspector to discuss limitations.

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

INDOOR ACTIVITY SPACE:
There are four preschool classrooms located in the facility (classroom #1, #2, #3, and #4). LPA observed a sufficient amount of equipment, toys, tables, chairs, napping cots, and cubbies in all rooms. There is one first aid kit located in every classroom as well as the outside storage. Medications will be stored in the office in a locked cabinet. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated drinking water will be provided via filtered water. LPA observed a functional carbon monoxide detector in each classroom. including written confirmation from the fire alarm company. Applicant stated they will be using an electronic sign-in and sign-out system and paper sign-in and sign out will be available as a back-up.

Report continues on LIC809 page 2.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: OLD FIREHOUSE SCHOOL
FACILITY NUMBER: 214005680
VISIT DATE: 07/02/2024
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Page 2.

LPA measured all four classrooms. The classrooms contain a total of 2,674.68 square feet, which will accommodate Applicant's request for 54 preschool children. There are 2 toilets and 1 sink located in each of the classrooms, total 6 toilets, and 4 sinks including an additional sink in classroom #1. LPA observed a separate private restroom for the staff located in the hallway. Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property located behind the facility. The outdoor play area is fenced with a variety of fencing types to include chain linked, wrought iron, and lattice fencing that is at least four feet tall. LPA observed a slide on a slope that has a rubber cushion to absorb falls. Per Jackie, the slope has a grade of approximately 20%. LPA observed sandboxes and the applicant was reminded that sandboxes shall be inspected daily and kept free of hazardous foreign materials. LPA observed a sufficient amount of equipment and toys. There is no play structure. There are no bodies of water on the premises. Shaded areas are supplied by trees and awning. There is an additional yard space, butterfly garden, that the applicant would like the children to have access to. LPA observed a part of the fencing enclosure not fully secured. The applicant was advised to ensure the full enclosure of the garden area. This area was not measured.

LPA measured the outdoor activity space. The outdoor play area contains a total of 7,195 square feet, which will accommodate Applicant’s request for 54 preschool children.

Report continues on LIC809 page 3.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: OLD FIREHOUSE SCHOOL
FACILITY NUMBER: 214005680
VISIT DATE: 07/02/2024
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant was 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, 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.

Applicant was informed of the MyChildCarePlan.org site, 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.

Report continues on LIC809 page 4.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: OLD FIREHOUSE SCHOOL
FACILITY NUMBER: 214005680
VISIT DATE: 07/02/2024
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Page 4

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.

Exit interview conducted and report was reviewed with the Applicant Dorothy Stewart and Director Susan Britson.

The following items are required before a license will be issued:
1. Amended granted STD850.
2. Submit proof of fixed fence in the butterfly garden.
3. Final determination from the Regional Manager regarding the slide on the slope
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jamel Maiwandi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4