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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700018
Report Date: 12/16/2019
Date Signed: 12/16/2019 12:53:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:DOWNTOWN CHILDREN'S CTRFACILITY NUMBER:
430700018
ADMINISTRATOR:MOMAND, MELISSAFACILITY TYPE:
850
ADDRESS:555 WAVERLYTELEPHONE:
(650) 321-9578
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:24CENSUS: 15DATE:
12/16/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Sarah HendersonTIME COMPLETED:
12:55 PM
NARRATIVE
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LPA Dayna Collier met with Assistant Center Director Sarah Henderson for a case management inspection as a result of receiving an unusual incident report. An incident occurred when staff began to transition children from the playground to the classroom. Children washed hands and began to position around the table for lunch. Staff observed that one child's place at the table was empty. The child was found in the sandbox outside of the classroom. Per staff, the child left through the open door of the classroom leading to the the sandbox which is located about 4-5 feet away from the door. Per staff, the child was without supervision for about 1 minute. The child's parents were informed of the incident. Per staff, additional steps were added to the transition procedures.

The attached type A deficiency is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.
A site visit notice was posted by staff.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: DOWNTOWN CHILDREN'S CTR
FACILITY NUMBER: 430700018
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2019
Section Cited

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time,
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This requirement was not met as evidenced by report review and interviews. This poses an immediate risk to children in care.
A CHILD WALKED OUT OF THE CLASSROOM WITHOUT STAFF'S KNOWLEDGE AND/OR OBSERVATION.
A LIC 421IM FORM WAS GIVEN TO DIR.
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A FUTURE VIOLATION WITHIN 12 MONTH PERIOD MAY RESULT IN A $1,000 IMMEDIATE CIVIL PENALTY.

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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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2019
LIC809 (FAS) - (06/04)
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