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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001721
Report Date: 05/13/2024
Date Signed: 05/13/2024 02:18:48 PM


Document Has Been Signed on 05/13/2024 02:18 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:CITY OF MENLO PARK-BELLE HAVEN SCHOOL-AGE CC PRGMFACILITY NUMBER:
414001721
ADMINISTRATOR:HOWARD, RONDELLFACILITY TYPE:
840
ADDRESS:100 TERMINAL AVE, BUILDING ATELEPHONE:
(650) 330-2245
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:71CENSUS: 0DATE:
05/13/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rondell Howard, Natalya Jones, Mayra MonjeTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPA’s) Kassandra Medrano and Diana Alvarado met with facility representatives, Rondell Howard, Natalya Jones, Mayra Monje for the purpose of conducting a Case Management Inspection. The facility submitted a request to change rooms from Portable A to Rooms 108 “Youth Center” and Room 143 “Events Space”. Fire clearance was approved and received on May 8, 2024, by Menlo Park Fire Department. The school age Program operates Monday through Friday from 12 PM to 6 PM, following the school district calendar. This program serves school age children. During the summer (mid-June to mid-August) facility operates 8 AM-6 PM. LPAs toured the facility during today's inspection as well as measured the space available for the children.
The following indoor measurements were taken today 05/13/2024:
Classroom 108 “Youth Center”: (44.465 x 34.652= 1540.80) (14.0 x 8.6=120.40) subtract 10.479 x 2.500 (encumbered space) = 26.20= 2824.67= 47 children
Classroom 143 “Event Space”: 31.614 x 37.631= 1189.67= 33 children
TOTAL INDOOR SPACE: 2704.27 sq. ft. divided by 35 sq. ft. = 80 children
Although LPAs measured a capacity for 80 children, based on fire inspection conducted on 5/7/2024 fire inspector approved a temporary maximum occupancy for room 108 of 34 children in the space due to occupancy of facility. Based on measurements and occupancy granted by Menlo Park Fire facility will be licensed for 67 children until they correct the occupancy in Room 108.
The following outdoor measurements were taken today 5/13/2024:
Playground: (63.773 x 54.6= 3482.01) + (50.11 x 37.7 = 1889.15) + (27.5 x 30.689=843.95) = 6215.10
TOTAL OUTDOOR SPACE: 6215.10 sq. ft. divided by 75 sq. ft. = 82 children
Facility began construction in 5/2022, and is therefore exempt from lead testing. LPAs observed documentation of construction plans. The facility has 9 toilets (135), 3 urinals (45) and 11 sinks (165) available for the children. There are two restrooms within the youth center, as well as facility will have exclusive access men’s and women’s bathrooms adjacent to event space classroom. The sinks used by children only have cold running water. The staff bathrooms are located on the second floor in the facility’s break room.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2024
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
SAN BRUNO CC RO, 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: 05/13/2024
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The isolation area for sick children will be in the director’s office and isolation equipment will be provided. Staff and children's bathrooms are clean, sanitary, and operable. Cleaning supplies are stored in the kitchen and are inaccessible and out of reach of children. LPAs observed smoke and carbon monoxide detectors, fire extinguishers, and appropriate lighting in each classroom. The facility has central heating and air conditioning. LPAs observed that all furniture and equipment indoors are in good condition and safe for the children. Drinking water is readily available for the children indoors via filtered water dispensers and disposable cups. There are 19 tables, 92 chairs, 48 cubbies. There are currently not enough cubbies to meet the requirement for the capacity requested. Facility representatives stated that they will be installing more cubbies as well as splitting the cubbies in half for children.
Facility representatives were reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
LPAs observed that the playground is surrounded by appropriate fencing and resilient material under and around the climbing structures. Shade for the playground is provided by trees and building overhang. There is a pool on campus in an off-limits area. LPAs observed that pool is surrounded by a fence that is higher than 4 feet in height. Facility representatives stated that they plan to allow use of the pool during summer program for children that sign up for swim lessons through “Menlo Swim and Sport.” LPAs discussed the topic and stated this would need to be discussed further before implementation.

LPAs advised Rondell Howard that a license for 67 school age children will be granted pending the receipt of the following items:
1) Photos documenting Classrooms 108 and 143 are fully set up for care with proper postings.
2) Documentation on licensing system for payments for annual fees
3) updated LIC 200 reflecting the new capacity
4) Submit updated facility sketches including entire campus with restrooms used by children, as well as to show proof of new build
5) Approval from Community Care Licensing Management.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Rondell Howard.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
LIC809 (FAS) - (06/04)
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