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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709757
Report Date: 08/15/2023
Date Signed: 08/15/2023 03:51:31 PM


Document Has Been Signed on 08/15/2023 03:51 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:PALO VERDE KIDS' CLUBFACILITY NUMBER:
430709757
ADMINISTRATOR:RANGEL, MANUELFACILITY TYPE:
840
ADDRESS:3450 LOUIS ROADTELEPHONE:
(650) 852-9475
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:65CENSUS: DATE:
08/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Rocio AndradeTIME COMPLETED:
04:05 PM
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On 8/15/23 at 1:45 PM, Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced case management inspection to change facility from inactive to active. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with Director Rocio Andrade and advised her the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 9 children in care and 4 staff at the time of the inspection.

Facility was inactive on 10/13/22 due to school construction and was not caring for children at this location (3450 Louis RD Palo Alto 94303). LPA took a tour of the facility with director Rocio; facility uses two portable classrooms and one bathroom. Director stated that portable bathroom is not able to flush due to construction, and facility is temporarily using a bathroom next to the portable. in the new wing of the school which staff will be escorting children to the bathroom and back. Director will be sending LPA a UIR (unusual incident report) regarding toilet unable to flush due to construction. LPA is aware of the broken toilet and temporary bathroom. LPA Michael advised Director to have a sign on the bathroom to indicate that bathroom is a child only bathroom for temporary use. the outdoor play area has ample amount of space for children to play. LPA observed tan bark and turf under the play structure to help protect the children when they fall.

This Facility is now on active status as of today 8/15/23.

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 reviewed with director Rocio.

No deficiency was cited in today’s visit.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: 510-292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2023
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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