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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005455
Report Date: 05/25/2021
Date Signed: 05/26/2021 04:56:18 PM

Document Has Been Signed on 05/26/2021 04:56 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:NORTH MARIN COMMUNITY SERVICES(PS)FACILITY NUMBER:
214005455
ADMINISTRATOR:PADDACK, CHERYLFACILITY TYPE:
850
ADDRESS:680 WILSON AVETELEPHONE:
(415) 892-1643
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY: 36TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
05/25/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Ruthie ReederTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Haydee Caliboso met with Ruthie Reeder for an announced case management inspection. The facility requested to make changes in classroom B and for an increase in capacity from 12 children to 15 children to the existing licensed childcare program and to remove toddler component program. The program has requested a total capacity of 39 children ages two to entry to Kindergarten. The program will operate Monday - Friday; 8:00AM to 5:00PM.

LPA toured the existing toddler classroom, which is set up for childcare. Existing areas on the license, indoor and outdoor, were observed to be clean, safe, and free from hazards. Present during today’s visit were 8 children and 2 teachers. The facility has obtained approval from Novato Fire Department for a capacity of 39 children.

Indoor:
Classroom B were measured to calculate capacity, and the following square footage was calculated for 528 sq ft., allowing for a capacity of 15 children. See facility sketch and capacity worksheet in file. The requested additional classrooms have a built-in counter-top and cabinets for storage. There is a total of 2 sinks and 1 toilet accessible for children to use in classroom B. The bathroom is clean and with no health or safety hazards. All cleaning supplies and hazardous items are stored in a locked cabinet made inaccessible to children. The applicant has submitted a letter for a waiver request for outdoor scheduled rotation.

LPA Haydee Caliboso will recommend licensure of this facility for a capacity of 39 children.

No deficiencies were observed today. Notice of site visit was observed to be posted and shall remain posted for 30 days.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2021
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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