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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415330
Report Date: 03/18/2021
Date Signed: 03/18/2021 10:24:01 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:STOCK FARM ROAD CHILDREN'S CENTERFACILITY NUMBER:
434415330
ADMINISTRATOR:J. FAJARDO & D. HOGUEFACILITY TYPE:
830
ADDRESS:183 STOCK FARM ROADTELEPHONE:
(650) 736-8465
CITY:STANFORDSTATE: CAZIP CODE:
94305
CAPACITY:48CENSUS: 8DATE:
03/18/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Hang DangTIME COMPLETED:
10:40 AM
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On March 18, 2021 at approximately 9:05am, LPA Haderer arrived for an unannounced case management visit to check that a Plan of Correction (POC) issued during complaint investigation on 2/4/2021 that hot water temperatures were too high in the Pokey Puppy classroom. The visit was to confirm corrections were made to bring the water temperatures in line with Title 22 regulations.

Program Director Ridhima Khanna had informed LPA that the maintenance department was given work orders to correct the problem and all work had been completed. Upon arrival, LPA met with facility administrator Hang Dang and proceeded to the Pokey Puppy classroom.

In the Pokey Puppy classroom there were 8 children in care and 3 teachers. The room air temperature was noted at 70 degrees. The hot water temperatures were tested on the 4 sinks in the classroom. The hot water temperature for the large sink on the left side of the counter was 97 degrees. The hot water temperature on the small children's sink in the middle of the counter was 95 degrees. The hot water temperature for the small children's sink on the right side of the counter was 96 degrees. The hot water temperature on the children's sink in the bathroom was 62 degrees. All sinks were under the 120 degree maximum temperature.

Copies of the completed work orders were provided to LPA and a photo of the heating unit was taken as well. All documents added to file.

LPA met with Program Director Ridhima Khanna and Hang Dang. The POC was cleared on this day. A copy of the cleared POC was given to the administrator.

LIC9213 Notice of Site visit was printed and will be posted for 30 days.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021
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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