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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700305
Report Date: 07/22/2021
Date Signed: 07/22/2021 10:42:32 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:MENESES MILLAN, CLAUDIAFACILITY NUMBER:
435700305
ADMINISTRATOR:MENESES MILLAN, CLAUDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 468-1788
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 9DATE:
07/22/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Sirly MolinaTIME COMPLETED:
10:41 AM
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ON 7/22/2021 Licensing Program Analyst (LPA) Morgan Pringle met with Assistant Teacher Sirly Molina for an unannounced Plan of Correction (POC) inspection. Present during the inspection were two (2) fingerprint cleared Assistants, Sirly Molina and Luz Stella Lievano. There were eight (8) preschool children and one (1) infant present during the inspection.

Deficiencies Corrected
· 102370(d)(1)(d) Unfingerprinted Adult
· 102416.5(d)(1) Facility out of Ratio
· 102416.1(a) All Personnel files missing
· 102421(b) Four (4) children’s files missing
· 102417(g)(8) Incomplete Facility Roster (LIC9040)
· 102417(g)(9)(A) Fire and Disaster Drill log incomplete

All six (6) deficiencies have been corrected. There are no deficiencies being cited today. A copy of cleared POC letter was given to Assistant Molina.

This report was read and given to the Assistant for a signature. This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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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