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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400049
Report Date: 06/08/2022
Date Signed: 06/08/2022 04:03:06 PM


Document Has Been Signed on 06/08/2022 04:03 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
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: 20DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Peggy Jane TriulziTIME COMPLETED:
04:14 PM
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On 6/8/2022, Licensing Program Analyst (LPA) Jonathan Williams met with facility Director, Peggy Jane Truilzi, for a Required 1 Year Inspection. Present for this inspection are the Director, four fingerprint cleared and associated staff members, and 20 preschool aged children in care. The facility was toured to conduct a health and safety inspection.

The facility consists of two classrooms (10 and 11). The classrooms were observed to be tidy and clean with heating and ventilation for safety and comfort. There are toys and learning materials in the facility. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture and equipment accessible to children were observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. The kitchen/food preparation area is free of litter, garbage, and evidence of rodents or other vermin. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. Solid waste storage vessels (garbage cans) have tight fitting covers and are in good repair. Uncontaminated drinking water is available to children inside the facility.

The outdoor activity spaces were toured and are in safe condition during this inspection. All play equipment is operable and age-appropriate. Outdoor activity spaces are free of unsafe or age-inappropriate items and furnishings at this time. Uncontaminated drinking water is available to children in the outdoor area. There are chickens and a rabbit kept in the outdoor activity area and the animals are kept inaccessible to children.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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 3


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: 06/08/2022
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The facility has a fully charged 3A40BC fire extinguisher, working carbon monoxide detector, and working telephone. Smoke detector is present in the facility and Director stated that it is serviced regularly by the City of Palo Alto. At least one staff present for today's inspection has a current CPR/1st Aid training certificate. The facility is in ratio today, with one teacher supervising no more than 12 children. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view, including menus. Facility roster was obtained. Fire/disaster drills are conducted at least once every 6 months. All children present during today's inspection were signed in by an authorized representative.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care at this time. IMS Plan of Operation is on file at this time. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free 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.”

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Director was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
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: COUNTRY DAY LITTLE SCHOOL
FACILITY NUMBER: 434400049
VISIT DATE: 06/08/2022
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There are no deficiencies cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director. Appeal rights were provided to the Director and the signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3