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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400203
Report Date: 09/26/2019
Date Signed: 09/27/2019 11:37:30 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:WHISTLE STOP, THEFACILITY NUMBER:
434400203
ADMINISTRATOR:VALERIE ROUTTFACILITY TYPE:
830
ADDRESS:3801 MIRANDA AVENUE #T6BTELEPHONE:
(650) 852-3497
CITY:PALO ALTOSTATE: CAZIP CODE:
94304
CAPACITY:48CENSUS: 30DATE:
09/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Valerie RouttTIME COMPLETED:
03:40 PM
NARRATIVE
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Unannounced random visit made by Analyst Mahvash Behbood. Met Valerie Routt, Site Supervisor. Purpose of the visit explained. Present also were 30 infants/toddlers and 8 staff. Operation hours is M-F from 6 to 6. Indoor and outdoor of the facility was toured.
Menu (for toddlers only) licenses, Personal Rights, Car Seat Poster & Parent's Rights are all posted.
Staff files were reviewed. Staff have current pediatric 1st aid/CPR.
Teacher/infant ratio was met during the visit.
Needs & Services plans were reviewed.
1st aid supplies are complete. There are no medications at the Center for any of the infants. Ms. Routt understands If/ when medication is accepted to administer by center all medication must be in their original container accompanied by parent's and physician's permission/direction in addition to the mediation log
Changing tables are within arms reach of a sink, have raised sides & a vinyl pad. Changing tables have cleaning wipes, and paper to cover the changing table after each use in addition to wipes.
Younger infants nap in cribs. Cribs are labeled. Older infants nap on mats
Infants have age appropriate toys/equipment including feeding chairs.
Bottles & food for infants are labeled. Sippy cups & water bottles are used for drinking water.
Center provides snacks for toddlers and older infants. Young Infant bring snack, meal and milk from home. Toddlers and older infants bring their lunch. Each classroom has small refrigerator.
All infants were visually supervised during the visit.
Infant/toddler playgrounds have rubber matting for cushioning
Sign in and out sheets were review, parents appears to sign in & out their children properly
Please see next page for citation under Title 22.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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 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: WHISTLE STOP, THE
FACILITY NUMBER: 434400203
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2019
Section Cited

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Modifications to Infant Needs and Services Plan - The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.
At least 6 children's needs and service plan was not updated quarterly. This is potentially harmful to health and safety of children.

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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) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 2 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: WHISTLE STOP, THE
FACILITY NUMBER: 434400203
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2019
Section Cited

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Criminal Record Clearance- All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility.
One staff is not associated to facility. This is dangerous to health and safety of children.

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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) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3