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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400049
Report Date: 06/23/2021
Date Signed: 06/23/2021 11:32:01 AM

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) 507-5787
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:40CENSUS: DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Ananda TriulziTIME COMPLETED:
11:43 AM
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On June 23, 2021 at approximately 8:08 am Licensing Program Analyst (LPA) Russ Haderer arrived to conduct an unannounced random annual site inspection for this preschool facility. LPA met with facility director, Ananda Triulzi and toured all areas licensed for use by children in care for a health and safety inspection. Also present at the time of this inspection were 5 teaching staff and 22 children in care (all preschool age). The facility is within ratio and capacity. All adults present are background cleared and associated to this facility.

The facility is located on a former elementary school owned by Palo Alto Community Child Care (PACCC) who lease former classrooms to day care providers. This facility consists of two classrooms (Appletree and Persimmon tree) with private playground space for the children. There is an additional area on the campus the child to use for gardening activities.

Both the Appletree and Persimmon tree classrooms were inspected. Both classrooms contain a small loft area, the Appletree classroom loft is used for staff storage and is off limits to children. Appletree also has a small kitchen area (not in use) with child proof latches on the cabinet doors, no hazards were noted.

Each classroom has a 3A40BC fire extinguisher, both fully charged with the last annual inspection done in February 2021. There are working carbon monoxide detectors (tested and working) and fire alarms mounted on the high ceilings. The Palo Alto fire department comes and tests the alarms annually. Plastic safety covers were present on electrical outlets, heating and ventilation was acceptable.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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 4
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
VISIT DATE: 06/23/2021
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There is a main kitchen in the Persimmon tree room used for preparing lunch and snacks (Menu posted) with a refrigerator, stove, dishwasher and a sink with hot and cold running water. The kitchen area is off limits to children and all sharp knives are stored high and out of reach of children. Cleaning chemicals and other cleaners are stored under the sink with a child-proof latch. Dry goods containers had tight fitting lids or were in sealed bags and all were checked for expiration dates. One jar of peanut butter was expired on May 2021.. Milk in the refrigerator was used for cooking, not for children to drink. All storage containers for solid waste had a tight-fitting lid. All surfaces accessible to children are clean and toxic free.

The facility is clean and well organized with age appropriate furnishings and equipment in good repair. There were no hazardous items/toxins observed to be accessible to children in care today. All required posted documents were present.

Disaster drills are conducted at least once every six months and were up to date as of April 22, 2021.

There is one shared bathroom for the children with 1 private stall for the staff and 3 working toilets for the children (all operational). Some potty training takes place, but no changing table is present at the preschool. Children are changed standing up. The sinks have functioning cold water taps with appropriate hand washing signs. There is a touch-free trash can with a lid and sufficient amount of towels, soap and diaper supplies. All toilets, hand washing and cleaning areas are in safe and sanitary operating condition.

The sign in/out sheets were reviewed, and the children are signed in. The sign in/out sheets going back a minimum of 30 days were reviewed.

There are ample age-appropriate toys that appear to be safe and in good condition. There are no bodies of water accessible to children in care. All hazardous materials and toxins are kept out of the reach of children.



Each classroom has touch-less trash can with tight fitting cover for the disposal of solid waste.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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
VISIT DATE: 06/23/2021
NARRATIVE
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Documents were posted in public places as required:
- Facility License
- Emergency Evacuation Plan
- Earthquake preparedness Notice
- Personal Rights
- Parents Rights
- Child Passenger Safety Laws
- There are no waivers or exceptions at this facility

No children in care require any incidental medications.

There are two playground areas, one in the front (including 3 caged chickens and a caged rabbit) and a playground area in the back area that has two sheds with cubbies and changing area for the children. There are gates with outside latches inaccessible to children. Teachers are always present in play areas when children are outside and there's a trash can with a tight-fitting lid. The play area is surrounded by a 6-foot privacy fence, all play equipment is in safe condition and free from sharp, loose or pointed parts.

Drinking water is available indoors and outdoors, due to covid, children are bringing in their own bottled water. Inside water is available on each table and if children drink their bottled water, more is available from the kitchen staff who provides filtered water from the sink area.

The children's napping areas are clean and organized with sleeping pads and cubbies for the children's personal items, none of the children's blankets were touching.

At approximately 10:00am LPA performed children's record reviewed: LPA requested and reviewed facility roster. All files selected were complete and up to date and found to be in compliance with Title 22 regulations.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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
VISIT DATE: 06/23/2021
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At approximately 11:00am LPA performed staff file review. All staff subjected to criminal review have been cleared and associated to the facility. All files were complete, up to date and found to be in compliance with Title 22 regulations. Mandated Reported was out of date on one employee (expired April 2021).

No deficiencies were cited at facility during today’s inspection. A copy of this report to remain on file for 3 years. Exit interview was conducted with site Director.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4