414001721-8-30-2022-05-CC-LTMO-CHT2RF-20220830173725

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001721
Report Date: 08/30/2022
Date Signed: 08/30/2022 05:38:44 PM

Document Has Been Signed on 08/30/2022 05:38 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CITY OF MENLO PARK-BELLE HAVEN SCHOOL-AGE CC PRGM		FACILITY NUMBER:	414001721
ADMINISTRATOR:	HOWARD, RONDELL		FACILITY TYPE:	840
ADDRESS:	100 TERMINAL AVE, BUILDING A		TELEPHONE:	(650) 330-2245
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	71	CENSUS: 32	DATE:	08/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Acting Recreation Coordinator, Mayra Monje		TIME COMPLETED:	04:40 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	On August 30th, 2022 at 1:55PM, Licensing Program Analyst (LPA) Tapia-Mandujano conducted an unannounced, annual, required inspection. LPA met with acting Recreation Coordinator, Mayra Monje and explained the purpose of the inspection. Upon arrival, there were only two children present an three staff. Throughout the inspection, more staff and children arrived. Present in the facility are six staff and 32 school age children. Children are picked up from elementary schools and arrive at facility approximately 3-3:15pm . All adults working in the facility are fingerprint cleared and associated. Facility operates M-F from 12pm-6pm, during the School District calendar and 8am-6pm during school breaks. Program offers Camps during Summer break.. Program operates in Building A during construction. Acting Recreation Coordinator and LPA toured the building for health and safety hazards. LPA observed the facility to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located inside the classrooms. LPA observed facility has an installation of a fire alarm system throughout the building. Facility has a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information. Medication is stored appropriately, inaccessible to enrolled children and maintained with proper documentation. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility's high shelves. Facility is offering snacks only. Water is available to children indoors and outdoors with children's water bottles. Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Facility has license documentation and information properly posted and available for review. LPA reviewed facility records that included 5 children's records, 4 staff records. LPA observed children's and staff's records to be complete. Teachers have valid CPR certificates. Last emergency drill was conducted over six months ago. Acting Recreation Coordinator, Mayra Monje agrees that an emergency drills must be conducted within a week. Moving forward, Emergency drills will be conducted at least once every month and are properly logged and documented. Continued on Page 2..

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CITY OF MENLO PARK-BELLE HAVEN SCHOOL-AGE CC PRGM	FACILITY NUMBER: 414001721
	VISIT DATE: 08/30/2022

NARRATIVE

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Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Directors were reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

No deficiencies were issued under CCR, Title 22, Division 12.

A notice of site visit was given and must remain posted for 30 days.

Due to technical issues, report was not printed at facility. Report and Notice of Site Visit will be emailed to licensee, Mayra Monje at mamonje@menlopark.org.

Exit interview conducted and report was reviewed with Acting Recreation Coordinator, Mayra Monje.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC809 (FAS) - (06/04)

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