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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414433
Report Date: 05/10/2019
Date Signed: 05/13/2019 08:20:22 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:STEPPING STONES PRESCHOOL & INFANT CAREFACILITY NUMBER:
434414433
ADMINISTRATOR:LINDER, KELLYFACILITY TYPE:
830
ADDRESS:201 COVINGTON ROADTELEPHONE:
(650) 559-1764
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY:20CENSUS: 15DATE:
05/10/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Kelly LinderTIME COMPLETED:
09:50 AM
NARRATIVE
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Licensing Program Analyst (LPA), Fermin Campos-Jaramillo, conducted an unannounced case management inspection to the center today. LPA met with Kelly Linder, Director, explained the nature of today's inspection to her. Licensee stated 15 infants are present today.

LPA wanted to verify that a member of the staff (Ashley Blevins) has been removed. Ashley no longer has a criminal record clearance. Ms. Linder stated that Ashley has been removed from the Infant program of the facility but Ashley is still working for the preschool program (license #434414434). Ms. Linder submitted today a completed form LIC300A for Removal of Ashley from the Infant program.

Type B deficiency was cited and cleared during today's visit.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: (408) 324-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019
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: STEPPING STONES PRESCHOOL & INFANT CARE
FACILITY NUMBER: 434414433
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2019
Section Cited
CCR
101170.1(a)
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The Department will notify a licensee to act immediately to terminate the employment of, remove from the facility or bar from entering the facility any person described in Sections 101170.1(a)(1) through (5) below while the Department considers granting or denying an exemption. Upon notification, the licensee shall comply with the notice.
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Licensee submitted a complete form LIC300A today, deficiency has been cleared today for the notifying requirement for the Infant program.
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This requirement was not met as evidenced by, Licensee did not submit the required "Confirmation of removal" form LIC300A on time, submitted the form on 05/10/2019. Licensee understands this poses a potential risk to the safety of the children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: (408) 324-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019
LIC809 (FAS) - (06/04)
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