435700749-11-30-2021-52-CC-MOTI-C99SMA-20211130125937

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700749
Report Date: 11/30/2021
Date Signed: 11/30/2021 12:59:43 PM

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:	NC & MT INC.		FACILITY NUMBER:	435700749
ADMINISTRATOR:	RODRIGUEZ, NOHORA		FACILITY TYPE:	850
ADDRESS:	1611 STANFORD AVENUE		TELEPHONE:	(650) 493-4300
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY:	30	CENSUS: 20	DATE:	11/30/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:43 AM
MET WITH:	Juan Prada Rodriguez		TIME COMPLETED:	01:22 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	Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct a PRE-LICENSING INSPECTION due to a CHANGE IN OWNERSHIP APPLICATION. Facility is changing from a Limited Liability Corporation to an Incorporation. This program is located on the premises of University Lutheran Church. Amigos de Palo Alto will be utilizing two classrooms, a library, dramatic play area and 2 play yard area. LPA was met by Secretary, Juan Prada Rodriguez and Applicant, Nohora Rodriguez. Present during today's visit were 4 staff members and 20 preschool aged children. LPA toured the facility both inside and out. Applicant has stated that there have been no changes to the square footage of either the indoor space or outdoor space. Measurements conducted by previous LPA for the facility are as follows: INDOOR MEASUREMENTS: 1267.13 sq ft = 36 children OUTDOOR MEASUREMENTS: 1568.86 sq ft = 21 children There are 2 sinks (30) and 2 toilets (30) available for the children. Only cold water is available in the children's sinks. There is a staff bathroom in the University Church which is located in the next building. The sick child will use the staff bathroom and will be escorted by a staff member. The sick child will be isolated in the library room and isolation equipment is provided. The children will not use the library room if it is occupied by a sick child. First aid supplies are stored in the hallway cabinet. The center will be administering medication. Children will bring their lunch and snacks from home. Facility has back up snacks should a child forget their food at home. There is a kitchen at the center which is equipped with hot and cold running water, refrigerators, microwave, toaster, stove, dishwasher, and oven. Trash cans with tight-fitting lids are located in the kitchen for the disposal of solid waste. Cleaning supplies are stored away from food within the kitchen. There are adequate toys, equipment, and supplies for the children. Drinking water is provided indoor via water dispensers and cups either brought from home or provided by the school. Room temperature is controlled by central heating/air conditioning. Some of the children will be attending the day-care part-time and will not nap at the center. See LIC 809C for 2nd page of report...

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

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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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: NC & MT INC.	FACILITY NUMBER: 435700749
	VISIT DATE: 11/30/2021

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The yards are surrounded by appropriate fencing. There is ample shade in the play yards. Yard 1 is located within the back of the preschool and contains a play structure and other age appropriate equipment. Play structure is cushioned by tanbark. Yard 2 is in the front of the preschool and is covered by an awning.

A fire clearance is approved by the Palo Alto Fire Department on 10/28/2021.

The center Director will be Nohora Rodriguez and a directors packet with all required documentation was submitted to CCL to complete the application.

This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

A license for 30 preschoolers operating out of 2 classrooms, a Library and a Dramatic Play area is recommended effective today, 11/30/2021.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

LIC809 (FAS) - (06/04)

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