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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005538
Report Date: 03/01/2022
Date Signed: 03/01/2022 04:23:31 PM

Document Has Been Signed on 03/01/2022 04:23 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:C.A.M. (CFS) MANZANITAFACILITY NUMBER:
214005538
ADMINISTRATOR:LOMBARDI, KELSEYFACILITY TYPE:
850
ADDRESS:630 DRAKE AVENUE, PORTABLE CTELEPHONE:
(415) 526-7500
CITY:SAUSALITOSTATE: CAZIP CODE:
94965
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 14DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Sanaa MehtarTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Haydee Caliboso met with Sanaa Mehtar (Lead Teacher) to conduct an unannounced annual inspection on 03/1/22. LPA arrived at the facility at 9:40AM. The purpose of the inspection was explained. Present during the inspection were 14 children and 3 staff. Facility is operating within the capacity and is following staff child ratio. Facility operates Monday – Friday, 8:00AM to 5:00PM in portable C. The facility was inspected today, indoors and outdoors for health and safety hazards.

LPA observed no bodies of water at the facility. Lead Teacher stated there are no firearms or weapons in the facility. The facility is equipped with smoke detector, carbon monoxide detectors, fully charged fire extinguishers and a working telephone available. The classrooms have adequate ventilation and lighting. LPA observed all cleaning solutions, poisons and other chemicals that are dangerous to the children are stored made inaccessible to the children. The classrooms are equipped with age-appropriate toys and furniture. The furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. LPA observed toilets and hand washing equipment are in working condition with proper sanitation in place. All storage containers for solid waste and in good repair and have proper tight fitted lid on top. The program has drinking water available for children for indoors and outdoors. Outdoor play area equipped with toys that are age appropriate and in good working condition. First aid kit and emergency supplies are properly maintained and kept inaccessible to children. Lead Teacher stated that there are no children in the program who currently have medication in care.
Cont. 809-C pg. 2
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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. (CFS) MANZANITA
FACILITY NUMBER: 214005538
VISIT DATE: 03/01/2022
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LPA reviewed personnel and children’s files during today’s inspection. LPA observed all files are complete and up-do-date. LPA observed facility has record of names, addresses and telephone numbers of each child 's authorized representative. Each child's record contains the record immunization. Multiple staff members have record of valid First Aid CPR card in file. LPA reviewed the educational qualification of all the teachers. Facility has a log for emergency drills being conducted. Per log, last emergency drill was conducted on 01/2022. Per Lead Teacher the program is not providing transportation.

The Lead Teacher was reminded about Mandated Reporter training available on the CCLD website. In addition to the AB1207 training must be completed every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. During the inspection, LPA observed multiple staff have completed the child abuse training. A copy of training certificate was kept in file. Lead Teacher was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare

LPA informed the Lead Teacher to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For rules and regulations, visit the website: www.cdss.ca.gov

Lead Teacher was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Cont. 809-C pg. 3
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
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. (CFS) MANZANITA
FACILITY NUMBER: 214005538
VISIT DATE: 03/01/2022
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

The report was emailed and reviewed by the Lead Teacher, Sanaa Mehtar. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was emailed to Sanaa Mehtar and Kelsey Lombardi (Director of Programs Operations) Today’s report and notice of site visit will be sent to the Teacher by the end of the day on 03/01/22. Confirmation of receipt is required.

>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Haydee R Caliboso
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
LIC809 (FAS) - (06/04)
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