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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004095
Report Date: 08/19/2021
Date Signed: 08/27/2021 01:10:23 PM

Document Has Been Signed on 08/27/2021 01:10 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:NATIVITY SCHOOLFACILITY NUMBER:
414004095
ADMINISTRATOR:VLAD, LAURAFACILITY TYPE:
850
ADDRESS:1250 LAUREL STREETTELEPHONE:
(650) 325-7304
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 39TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/19/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Laura VladTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA), Leslit Tapia-Mandujano conducted a scheduled Case Management inspection and met with Director, Laura Vlad. Purpose of the inspection was explained. First day of school is scheduled for 08/24/21, so no children were present during the inspection. Facility operates Mon-Fri, 8a-3p. Extended hours will be from 3:15p-5:45p, following the school calendar. Facility operates on the Nativity Elementary School site in the ‘Pre-Kindergarten’ classroom. LPA and Director inspected the facility indoors and outdoors for Health and Safety hazards. Classroom has sufficient age appropriate toys and equipment. Hooks, located in the School hallway, are used to store children’s belongings. Classroom has two restrooms, each with 1 toilet and 1 sink, with an additional sink in the classroom. An additional toilet and sink is located in the Staff restroom, designated exclusively for Preschool children’s use. Program has a total of 3 toilets and 5 sinks available for children’s use.

LPA and Director discussed the following: Covid-19 protocols, age group of children in care, employees associated to the facility, and record keeping. Director will submit some updated forms to the department prior to first day of school.

***No deficiencies were cited against the facility under CCR,Title 22, Div. 12, Ch. 1. ***
>This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Any additional questions to call Office, M-F, 8a-5p, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2021
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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