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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002020
Report Date: 02/12/2024
Date Signed: 02/12/2024 12:13:17 PM


Document Has Been Signed on 02/12/2024 12:13 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:CITY OF MENLO PARK-MENLO CHILDREN'S CTR-PRESCHOOLFACILITY NUMBER:
414002020
ADMINISTRATOR:CHAW, SHERIANNFACILITY TYPE:
850
ADDRESS:801 LAUREL STREETTELEPHONE:
(650) 330-2260
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:72CENSUS: 21DATE:
02/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director, Sheriann ChawTIME COMPLETED:
12:35 PM
NARRATIVE
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On February 12th, 2024, at approximately at 8:45am Licensing Program Analysts (LPA) Tapia-Mandujano arrived at the facility to conduct a complaint inspection. Present in the facility are 6 staff supervising a total of 21 children (6 children are in the toddler component).

During the physical plant inspection, LPA was accounting for adults supervising the children and cross referencing Guardian Roster. At approximately 10am, one staff member arrived who did not have fingerprint clearance or is associated. Please refer to LIC 809D for Type A deficiency. Civil penalties were assessed.

Deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

LPAs informed Director, Sheriann Chaw that this report dated 02/12/24 documents a Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the Director, Sheriann Chaw to provide a copy of this licensing report dated 02/12/24 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


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

Exit interview conducted and report was reviewed with Director, Sheriann Chaw.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 02/12/2024 12:13 PM - It Cannot Be Edited

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: CITY OF MENLO PARK-MENLO CHILDREN'S CTR-PRESCHOOL
FACILITY NUMBER: 414002020

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/13/2024
Section Cited
CCR
101170(e)(1)

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101170(e)(1): Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department

This requirement is not met as evidenced by:
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Director understands that all adults supervising children must have fingerprint clearance prior to working or volunteering with children.


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Based on interviews, Observations, and record review, the licensee did not comply with the section cited above, as there is an individual who is not fringerprint cleared, which poses an immediate health, safety or personal rights risk to persons in care.
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Director sent individual to go get fingerprinted as LPA was still in the facility.

Civil penalties were assessed.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2024
LIC809 (FAS) - (06/04)
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