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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430702323
Report Date: 08/20/2019
Date Signed: 08/20/2019 05:05:22 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:NEIGHBORHOOD INFANT-TODDLER CENTERFACILITY NUMBER:
430702323
ADMINISTRATOR:KIMBERLY WARFIELDFACILITY TYPE:
830
ADDRESS:311 NORTH CALIFORNIA AVENUETELEPHONE:
(650) 321-3493
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:12CENSUS: 7DATE:
08/20/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Melissa Momand TIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Zaid Hakim and Monica Mathur conducted an Unannounced Case Management - Incident Inspection at the facility today. Upon arrival, LPA observed seven (7) infants and at least five (5) staff engaging in daily activities and met with the Interim Director Ms. Melissa Momand. The purpose of the inspection is to review an incident that occurred at the facility on 07/25/19 involving Staff #1 (S-1), Staff #2 (S-2) and Child #1's (C-1) needs not being met by facility staff. The facility self reported this incident to Community Care Licensing on 07/25/19 and has met the reporting requirements for unusual incident reporting. LPA toured certain areas of the facility, conducted phone interviews with facility staff and third parties, and reviewed child and personnel records.

On 07/25/19, C-1 accompanied by their Parent, arrived to the facility in need of a diaper change. Parent informed facility staff and requested that C-1 be changed. S-1, a fully qualified teacher, informed Parent that due to health / physical restrictions, they are unable to perform this responsibility at this time. Facility representatives stated that S-1 then informed Parent that S-2 cannot perform this responsibility due to internal policies and procedures. The facility begins operation at 7:30am and only S-1 and S-2 were on site with the next staff member arriving at 8:15am. C-1 was signed into the facility at approximately 7:40am. Parent then changed C-1, briefly left the facility, and returned to sign C-1 out at 8:41am. Parent expressed concerns to facility representatives who clarified internal policies and procedures to staff and families. As of 08/20/19 S-1 and S-2 are currently not working at the facility.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.

Deficiencies have been cited as a result of today's inspection. Refer to page 809-D for citations, descriptions, and plans of correction. Appeal rights have been provided and discussed.

Exit interview conducted with Ms. Melissa Momand.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 497-9236
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019
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: NEIGHBORHOOD INFANT-TODDLER CENTER
FACILITY NUMBER: 430702323
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2019
Section Cited

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Personal Rights
The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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S-1, S-2 failed to meet C-1's needs evidenced by not performing diaper change. S-1, S-2 did not perform job responsibilities and were unable to provide a reasonable solution to meet C-1's needs. This presents a potential risk to the health and safety of children in care.
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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: Anthony StudebakerTELEPHONE: (408) 497-9236
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2019
LIC809 (FAS) - (06/04)
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