434404887-5-26-2022-52-CC-JWIS-CESV55-20220526160722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404887
Report Date: 05/26/2022
Date Signed: 05/26/2022 04:07:27 PM

Document Has Been Signed on 05/26/2022 04:07 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:	BESSE BOLTON KIDS CLUB		FACILITY NUMBER:	434404887
ADMINISTRATOR:	LOZANO, RENITA		FACILITY TYPE:	840
ADDRESS:	500 EAST MEADOW		TELEPHONE:	(650) 856-0847
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY:	80	CENSUS: 21	DATE:	05/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:47 PM
MET WITH:	Renita Lozano		TIME COMPLETED:	04:21 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	On 05/26/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Required 1-Year Inspection. LPA was met by Director, Renita Lozano. Present for this inspection are the Director, four fingerprint cleared and associated staff members, and 21 school-aged children in care. Facility operating hours are 10am-6pm M-F. The facility was toured to conduct a health and safety inspection. At 1:50pm, LPA toured the facility classroom. The facility operates in portable classrooms 1, 2, and 3 on the site of Fairmeadow Elementary School. The rooms are tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the rooms. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Snack food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children inside and outside the facility. LPA observed adequate amounts of hand soap and paper towels in the bathrooms during this inspection. Bathrooms are clean and in good repair. Toilets and sinks are operable during this inspection. At 2:31pm, the outdoor activity area was inspected. All play equipment was observed to be operable and age-appropriate during this inspection. Uncontaminated drinking water is available to children in the outdoor areas. Cushioning material is present to absorb falls where there is high climbing equipment. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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: BESSE BOLTON KIDS CLUB	FACILITY NUMBER: 434404887
	VISIT DATE: 05/26/2022

NARRATIVE

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The facility has multiple fully charged 3A40BC fire extinguishers detectors and working telephone. Carbon monoxide and smoke detector (combined) is fully functional. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view. All children present during today's inspection were observed to be signed in. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated Plan for Providing IMS must be submitted to the Department. 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.

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 Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

LIC809 (FAS) - (06/04)

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