Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210110892
Report Date: 09/20/2017
Date Signed 09/20/2017 05:05:07 PM

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:CITY OF SAN RAFAEL/VALLECITO SCHOOL AGEFACILITY NUMBER:
210110892
ADMINISTRATOR:CERUTTI, PATRICIAFACILITY TYPE:
840
ADDRESS:50 NOVA ALBIONTELEPHONE:
(415) 485-3103
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:119CENSUS: 60DATE:
09/20/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kelly Albrecht, Trisha Cerutti SaylorTIME COMPLETED:
05:15 PM
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Licensing Program Analysts (LPAs) Leung and Manlutac met with Site DirectorCerruti-Saylor for an Annual inspection today at this facility. Program Director Albrecht is assisting at this site. Present are 60 children with 3 other staff and 2 student volunteers. This is an after-school program ran by City of San Rafael, it is located at the campus of Vallecito Elementary School (TK - 5th grade). This program runs from 11:50am to 6:30pm on school days. No morning program. Full day program on non-school days, 7:30am - 6:30pm. Classroom 42, Cafe Val, and the Gym are the regular rooms for this program. This program has access to classroom 41 if needed. Cafe Val was used for showing movie today. Some children were playing in the gym. Children get to choose different acitivity. Children use the school boys and girls bathrooms by Cafe Val. More boys and girls bathrooms are in the gym. Variety of toys and learning materials for children are available in the classroom. There is a quiet room for doing craft work inside classroom 42. Children's medication and first aid supplies are stored in the upper kitchen cabinet. There are charged fire extinguishers in the classroom. Smoke and carbon monoxide alarms are in Rm #42. This center provides snacks to children. Last fire drill was conducted on 8/30/17. Sign in/out sheets were reviewed. At least tow staff have First Aid/ CPR cards, expire on 2/14/2019.

This report and a Notice of Site Visit are provided to Program Director Albrecht.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2017
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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