Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210111538
Report Date: 12/20/2016
Date Signed 12/20/2016 03:33:29 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:C.A.M.-NOVATO CHILDREN'S CENTER (SA)FACILITY NUMBER:
210111538
ADMINISTRATOR:JENNIFER CARLFACILITY TYPE:
840
ADDRESS:5520 NAVE DRIVETELEPHONE:
(415) 883-4385
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY:44CENSUS: 5DATE:
12/20/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Site Supervisor, Sonia VelasquezTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Avila met with Site Supervisor, Sonia Velasquez for an unannounced annual/random inspection. The purpose of the inspection was explained. The facility was toured indoor and outdoors for health and safety hazards. Present today are 5 school age children with the site director. Staff to child ratio is met today. Sign in sheets were reviewed. Currently room 8 is being used for the school age program. Room 7 is functioning as a staff lounge and as the Site Supervisor's office.

Site supervisor states, there are no bodies of water or firearms or other weapons on the premises. All disinfectants, cleaning solutions and other toxic items are stored inaccessible to the children. The classroom furniture is is good condition free of sharp, loose or pointed parts. There are two toilets and three sinks for children's use. Children's bathrooms are clean and in good repair. There is a separate bathroom on site for staff and other adults. The floors are clean and free of debris or other tripping hazards. Indoor and outdoor drinking water is available, children refill their water bottle at the center's sinks and outdoor water faucet. The center provides snacks to the children. Menus are posted by the classroom entrance. All solid waste storage containers have tight secure fitting lids. The center has a working land line telephone, fully charged fire extinguisher and carbon monoxide and smoke detector. The playground is completely fenced and outdoor activity space surfaces are free of hazards. The center does not have any high climbing structures, the center provides balls and other equipment for children to play.. At least one staff member has a current CPR that is expiring on 10/2017.

Site supervisor is advised all adults, teachers or teacher's aide must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with copy of CDL or Ca. ID prior to having any contact with children in care failure to do so could result in an immediate civil penalty of $100.00 each day.

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SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Ofelia AvilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2016
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: C.A.M.-NOVATO CHILDREN'S CENTER (SA)
FACILITY NUMBER: 210111538
VISIT DATE: 12/20/2016
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Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care 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.”

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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.

LPA provided the Community Care Licensing website (www.ccld.ca.gov), so the licensee can obtain updated licensing information, new regulations and access forms.



No deficiencies were observed today.

>This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site visit was observed being posted.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Ofelia AvilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2016
LIC809 (FAS) - (06/04)
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