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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 210103121
Report Date: 10/28/2025
Date Signed: 10/28/2025 03:42:44 PM

Document Has Been Signed on 10/28/2025 03:42 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:MARIN PRIMARYFACILITY NUMBER:
210103121
ADMINISTRATOR/
DIRECTOR:		AMY TAYLORFACILITY TYPE:
850
ADDRESS:20 MAGNOLIA AVENUETELEPHONE:
(415) 924-2608
CITY:LARKSPURSTATE: CAZIP CODE:
94939
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 81DATE:
10/28/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:41 AM
MET WITH:Director, Amy TaylorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On October 28, 2025 at approximately 9:45AM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced, annual inspection. LPA met with Director, Amy Taylor, and explained the purpose of the visit. Present during the visit was Director, 18 staff, and 81 preschool age children.

The facility operates on the campus of Marin Primary in classrooms Jungle, Mountain, Ocean, Forest, Meadow, Seashore, Buckeye, and Sequoia. Hours of operation are Monday to Friday from 7:30AM – 6:00PM.

LPA inspected all preschool classrooms for health and safety hazards with Director. LPA observed electrical outlets in classrooms to be made inaccessible with child safety covers. Facility is equipped with a fully charged fire extinguisher, first aid kits, and a fire alarm system. LPA verified there was a carbon monoxide detector on site. Children’s medication are located in the nurse’s office and LPA observed them to be appropriately stored. Chemicals, poisons, and cleaning solutions have been made inaccessible to children.

LPA observed a variety of age-appropriate toys that are in good condition. Classrooms have fine motor play areas, art tables, and areas for rest and relaxation. Age-appropriate furniture was observed to be maintained in good condition, free of sharp, loose or pointed parts. LPA observed cabinets and drawers in classrooms to be free of poisonous materials. Personal storage for children's belongings is located inside the classrooms and are labeled with their names. First aid kits were observed to be in fanny packs and emergency backpacks.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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Document Has Been Signed on 10/28/2025 03:42 PM - It Cannot Be Edited


Created By: Nicole Tran On 10/28/2025 at 03:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MARIN PRIMARY
FACILITY NUMBER: 210103121

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 6 personnel files did not have their MMR and/or TDAP immunizations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2025
Plan of Correction
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Director or facility personnel will email LPA evidence of MMR and/or TDAP immunization for four staff members by 12/05/2025.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 6 out of 6 personnel files did not contain current pediatric CPR/First Aid training by an approved child care provider trainer, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2025
Plan of Correction
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Director will email LPA evidence of at least one staff member completing a pediatric CPR/First Aid training course by an approved child care provider trainer by 12/05/2025 . Approved trainers can be found at https://emsa.ca.gov/childcare_provider/
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Nicole Tran
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2025


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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARIN PRIMARY
FACILITY NUMBER: 210103121
VISIT DATE: 10/28/2025
NARRATIVE
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Restrooms for children's use were observed to be in working condition. LPA observed children's restroom to have age-appropriate toileting equipment and hand washing materials. Classrooms had changing tables that were within arm’s reach of a sink. Per Director, parents provide diapers and LPA observed them to be individually stored and labeled per child.

Children sleep on cots and mats. Sheets are provided by the facility while blankets are provided by families. Per Director, the facility launders sheets weekly and families bring home blankets to wash weekly as well. LPA observed children’s bedding to be individually stored so that no child’s used bedding comes into contact with other bedding. The facility uses disinfectant wipes to clean mats weekly.

Children bring snacks and lunch from home. Per Director, the facility has emergency snacks if needed. Children also bring water bottles from home and teachers will refill them at the filtered water dispenser in the hallway.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.




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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARIN PRIMARY
FACILITY NUMBER: 210103121
VISIT DATE: 10/28/2025
NARRATIVE
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With Director, LPA inspected the outdoor area for health and safety hazards. Outdoor area is fully enclosed and fully fenced. In the play area next to the Jungle classroom, there are two separate fenced off zones for children to play in and to ensure supervision. There are play structures and a sandbox for children to play with. Trees and structures provide shade for children to rest under. Age-appropriate toys and equipment were observed to be in good condition. There is a sandbox that has a cover on when not in use to prevent debris and loose articles from falling in. Per Director, the facility checks the sandbox daily for any hazardous objects. The facility also has access to a portion of Marin Primary School’s playground. The area has a play structure, swings, and sand box for children’s use. Woodchips and rubber mats are underneath the swings and play structure to cushion falls. Per Director, the facility has scheduled time at the playground. LPA did not observe any pools, spas or bodies of water on site.

Licensing documents are properly posted and available for review by the director’s office. Per Director, the facility conducts emergency disaster drills often. The last disaster drill conducted was on 10/23/2025. The facility utilizes paper sign-in sign-out sheets that are placed at the entrance of each classroom. LPA observed children present to be appropriately signed in during today's visit.

LPA reviewed 6 random children's records. Children's files were observed to be complete and included emergency information and immunization records. LPA reviewed 6 staff files and all included tuberculosis clearance. 4 out of 6 files reviewed did not have the employee’s MMR immunization available for review. 2 out of 6 files did not have the employee’s TDAP immunization available for review. Staff files reviewed had CPR/First Aid training, but the course was not by an approved childcare provider trainer. 2 out of 6 files did not have the correct mandated reporter training completed.

Facility representative was reminded that all adults 18 and over, 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.

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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARIN PRIMARY
FACILITY NUMBER: 210103121
VISIT DATE: 10/28/2025
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.

For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; 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.

See LIC 809-D for Type B deficiencies cited today regarding staff immunizations and pediatric CPR/First Aid training.

See LIC 9102-TV for technical violation issued regarding mandated reporter training.

A notice of site visit was given and must remain posted for 30 days.

Appeal rights were provided and explained.

Exit interview conducted and report was reviewed with facility representative, Amy Taylor.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC809 (FAS) - (06/04)
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