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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407972
Report Date: 04/01/2022
Date Signed: 04/01/2022 03:03:01 PM


Document Has Been Signed on 04/01/2022 03:03 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:DISCOVERY CHILDREN'S GARDENFACILITY NUMBER:
434407972
ADMINISTRATOR:BONNIE MATHISENFACILITY TYPE:
850
ADDRESS:437 WEBSTER STREETTELEPHONE:
(650) 329-8023
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY:68CENSUS: 0DATE:
04/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Bonnie MathisenTIME COMPLETED:
03:22 PM
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On 4/1/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Case Management visit to clear deficiency. LPA was met by Director, Bonnie Mathisen. Present for this inspection are the Director, one fingerprint cleared and associated staff member, and zero children in care. Facility operating hours are 8:30am-5:30pm M-F.

During visit conducted on 3/24/2022, one Type B deficiency was assessed because personnel file for Director was not present at facility. During today's inspection, LPA observed that facility file for Director has been returned to the facility. LPA reviewed file for proper documentation. Director produced a written and signed letter acknowledging the requirement to maintain personnel records of all staff on the facility premises for Departmental review.

Deficiency cleared. Exit interview conducted. Appeal Rights provided.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/01/2022
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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