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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002032
Report Date: 05/08/2019
Date Signed: 05/08/2019 04:23:47 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:CITY OF MENLO PARK-MENLO CHILDREN'S CTR-SCHOOL-AGEFACILITY NUMBER:
414002032
ADMINISTRATOR:BONHAM, NATALIEFACILITY TYPE:
840
ADDRESS:801 LAUREL ST., RM 118A,B,&CTELEPHONE:
(650) 330-2260
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:102CENSUS: 55DATE:
05/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Senior Program Assistant, Da'Shawn Williams and Recreations Supervisor, Natalia JonesTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA), Cindy Interiano, conducted an Annual/Random inspection this day and met with Senior Program Assistant, Da'Shawn Williams and Recreations Supervisor, Natalia Jones. Purpose of the inspection was explained. Facility operates M/Tu/W/F, 2:30p-6p, and Thursdays from 1p-6p, during the School District calendar. Program offers Camps during Summer break and school breaks and operate from 8a-5:30p. Program operates in Rooms 118A, B, and C, and ‘Kinder Cats’ classroom during the academic calendar. LPA, Senior Program Assistant, and Recreations Supervisor inspected the facility indoors and outdoors for Health and Safety hazards. Present during the inspection is Senior Program Assistant and Recreations Supervisor and 7 Staff supervising 55 School Age children. Classrooms have age appropriate toys and equipment, maintained in good condition. Hooks and Bins are used to store Children’s belongings and are located inside the classroom. Classroom has 2 restrooms: Boys’ Restroom with 1 Toilet and 1 urinal, and a Girls’ Restroom with 2 Toilets. In-between the restrooms are 3 sinks. Restrooms are kept clean, in good repair, and maintained with adequate supplies. Staff restroom is maintained off limits to children. Program provides daily snacks and children bring their own meals. Classroom has proper ventilation and sufficient lighting. Cleaning products and Toxins are maintained inaccessible to children. Facility has a fully supplied Emergency Kit and Emergency supplies, which are maintained inaccessible to children. Facility is equipped with an industrial fire alarm system, a carbon monoxide detector, and a Fire Extinguisher. Last Emergency Disaster drill was conducted on 01/31/19 and is properly logged. Outdoor play areas are free of debris and dangerous conditions. A daily sweep is conducted by staff of the outdoor play area prior to the children going out for outdoor play. All outdoor toys and equipment are age appropriate and in good repair. Drinking water is readily available indoors and outdoors. All required postings are properly posted near the main entrance of the facility. All staff have required immunization and Mandated Reporter training certificate on file.

See Page 2. . .
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
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
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: CITY OF MENLO PARK-MENLO CHILDREN'S CTR-SCHOOL-AGE
FACILITY NUMBER: 414002032
VISIT DATE: 05/08/2019
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During inspection,
*Incidental Medical Services (IMS) policy was discussed.
*Senior Program Assistant and Recreations Supervisor were reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
*Senior Program Assistant and Recreations Supervisor were reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare.
*Senior Program Assistant and Recreations Supervisor were reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com)
*Senior Program Assistant and Recreations Supervisor were reminded about the Provider Information Notices (PINs) on CCLD website.

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Ch. 1. ***

>This report and rights to comment and appeal were discussed with Senior Program Assistant and Recreations Supervisor. This report must be available in the facility for public review. Notice of site inspection was posted. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
LIC809 (FAS) - (06/04)
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