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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400049
Report Date: 11/15/2019
Date Signed: 11/15/2019 03:05:33 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:COUNTRY DAY LITTLE SCHOOLFACILITY NUMBER:
434400049
ADMINISTRATOR:PEGGY JANE TRIULZIFACILITY TYPE:
850
ADDRESS:3990 VENTURA COURTTELEPHONE:
(650) 494-8044
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:40CENSUS: 16DATE:
11/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Amanda TriulziTIME COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marilou Monico met with Assistant Director, Amanda Triulzi, for a follow-up case management inspection. An initial inspection was conducted by LPA Monico on August 16, 2019 in response to an unusual incident that was reported to Licensing on July 17, 2019. The unusual incident was reported to the facility on July 2, 2019. Investigator Marianna Lomeli also conducted an investigation and staff admitted to placing their legs on the daycare children's legs during nap time.

As a result of this inspection, deficiencies were cited on the following page:

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 334-8549
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 277-2053
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: COUNTRY DAY LITTLE SCHOOL
FACILITY NUMBER: 434400049
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2019
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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The above requirement is not met as evidenced by: Staff admitted to placing their legs on the daycare children's legs during nap time. This pose a potential risk to the health and safety to children in care.
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Type B
11/18/2019
Section Cited

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Reporting Requirements - Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1), a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report shall be submitted to the Department within seven days following the occurrence of such event.
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The above requirement is not met as evidenced by: An unusual incident was not reported to Licensing within the required time frame. This pose a potential risk to the health and safety to 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) 334-8549
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 277-2053
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2019
LIC809 (FAS) - (06/04)
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