Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005036
Report Date: 01/16/2018
Date Signed 01/16/2018 03:18:17 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:MARIN YMCA @ PLEASANT VALLEYFACILITY NUMBER:
214005036
ADMINISTRATOR:KIRSTEN MOGENSENFACILITY TYPE:
840
ADDRESS:755 SUTRO AVENUETELEPHONE:
(415) 892-7476
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:100CENSUS: 20DATE:
01/16/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Director of Youth Development - Torrey Kelly, Site Coordinator - Wayne EverbeckTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Manlutac performed a required 3 year inspection at the facility at issue. LPA met with Director of Youth Development, Torrey Kelly, and Site Coordinator, Wayne Everbeck, purpose of the visit was explained. Facilities hours of operation are: Monday thorugh Friday, 7:00 AM - 8:30, 1:00 - 6:30 PM.

LPA inspected indoor and outdoor areas for health and safety hazards. LPA did not observe any bodies of water, per director there are no fire arms or weapons on the premises. Cleaning supplies are locked away in a cabinet. The two portable classrooms were equipped with carbon monoxide detectors and fully charged fire extinguishers that meet minimum size requirements (2A10BC). LPA observed that the center is equipped with a sufficient amount of learning materials and furniture that are in good repair. Kitchen and bathroom surfaces are sanitary and free from clutter. Floors are clean and safe, trash receptacles are covered with tight fitting lids. Drinking water is readily available to children via water fountains. Outdoor space is free from hazards. Snack is served, menus is posted on a white board in one of the portable classrooms.

Children and staff files were reviewed for required licensing documents. All children files were complete and had up to date licensing documents. All staff files were complete and current. First aid/CPR certifications were current, staff had complete and current immunization records, fully qualified teachers had proof of the required amount of ECE units.

No deficiencies are cited on this day.

A copy of this report was reviewed and left with the director, along with a notice of site visit which is to be posted
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Lorenzo ManlutacTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2018
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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