430710084-6-10-2021-52-CC-JSAR-C3V2FB-20210610172115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710084
Report Date: 06/10/2021
Date Signed: 06/10/2021 05:21:34 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:	CHILDREN'S HOUSE OF LOS ALTOS		FACILITY NUMBER:	430710084
ADMINISTRATOR:	ELLA M.MAYON		FACILITY TYPE:	840
ADDRESS:	770 BERRY AVENUE		TELEPHONE:	(650) 968-9052
CITY:	LOS ALTOS	STATE: CA	ZIP CODE:	94024
CAPACITY:	40	CENSUS: 0	DATE:	06/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Christopher Mayon		TIME COMPLETED:	04:56 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) James Sampair conducted an unannounced random annual site inspection of this facility at 12:25PM. At arrival, LPA met with facility Administrator (ADM) Christopher Mayon. ADM Mayon assisted LPA with a tour of all areas of the facility inside and outside. The visit was conducted during the summer break, so 0 children and 0 teaching staff were present for the school-age program. When children are present, the program operates in 3 classrooms that have age-appropriate furnishings and equipment free of broken or sharp pieces. Counters and surfaces, including floors, are free of toxins. There are no hazardous items/toxins observed to be accessible to children in care. This year, the children bring their own snacks. The outdoor play areas are fully fenced with age-appropriate climbing equipment and slides in the play area that are securely anchored with cushioning under and around the structures. There are no pools or other bodies of water accessible to children. There are fully charged fire extinguishers in each of the classrooms and the facility has a centralized smoke and fire alarm system and a functioning carbon monoxide detector in each classroom. Per the ADM, there are no firearms present or stored on the premises. 6 children's files were reviewed and they were complete. 4 staff records were reviewed and they were complete. More than one staff member present has current CPR/First Aid certification. All required postings were present.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

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: CHILDREN'S HOUSE OF LOS ALTOS	FACILITY NUMBER: 430710084
	VISIT DATE: 06/10/2021

NARRATIVE

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This facility provides Individual Medical Services (IMS). LPA reviewed storage of medication, equipment, and supplies, and they were found to be handled in accordance with regulations. For IMS information, see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information was provided: US Department of Justice (USDOJ) toll-free Americans with Disabilities Act (ADA) Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Facility Staff are encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. Staff are also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. Facility administrator was provided with CDSS Effects of Lead Exposure Informational and lead testing requirements were discussed.

No deficiency cited during today’s visit. The appeals rights and a notice of site visit were provided that is to be posted for 30 days. A copy of this report was provided and is to be kept in the facility records for a period of three years.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James Sampair	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

LIC809 (FAS) - (06/04)

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