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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004816
Report Date: 01/07/2025
Date Signed: 01/07/2025 11:40:09 AM

Document Has Been Signed on 01/07/2025 11:40 AM - 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:WHOLE KID SCHOOLFACILITY NUMBER:
414004816
ADMINISTRATOR/
DIRECTOR:		DOAN, MICHELLEFACILITY TYPE:
830
ADDRESS:135 WILLOW ROADTELEPHONE:
(650) 382-9388
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
01/07/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Director, Michelle DoanTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
NARRATIVE
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On 1/7/2025, at approximately 9:00AM, Licensing Program Analysts (LPAs) Jonathan Tse and Katie Krenn arrived at the facility to conduct an unannounced Plan of Correction (POC) visit. LPAs met with Director Michelle Doan (D1) and explained the purpose of the visit. Present during the visit was D1, three staff, and eight infants.

During an annual visit on 12/4/2024, LPAs issued two citations due to the facility using sleep sacks for sleeping infants and not maintaining complete personnel records for all staff on site available for review. LPAs established a plan of correction with D1 and due dates were agreed upon.

The facility completed the plan of correction for sleep sacks and submitted proof of completion to LPAs on 12/5/2024. LPAs did not observe any sleep sacks during the inspection.

During today's visit, LPAs reviewed staff records and observed files to be incomplete. Based on record review, LPAs observed that staff files were missing immunization records, signed health screening reports, and documentation of staff qualifications via transcripts. LPAs informed D1 that the deficiency cited on 12/4/2024 for maintaining personnel records was unable to be cleared on this date and that a civil penalty for failure to correct would be issued.

LPAs advised that in case of unexpected absences, more than one staff member present on site should have current Pediatric First Aid/CPR training on file.

See LIC809-D for deficiency cited regarding personnel files. A plan of correction was discussed and a due date of 2/7/2025 agreed upon. Appeal rights were provided and explained to D1.

A notice of site visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Michelle Doan.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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Document Has Been Signed on 01/07/2025 11:40 AM - It Cannot Be Edited


Created By: Jonathan Tse On 01/07/2025 at 10:33 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: WHOLE KID SCHOOL
FACILITY NUMBER: 414004816

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2025
Section Cited
CCR
101217(d)

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(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement was not met as evidenced by:
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Licensee shall ensure that all staff files are complete and contain all required files as listed in LIC126. LPAs provided Director with a list of all missing documents for staff files reviewed on this date. Missing documents shall be emailed to LPAs by set due date of 2/7/2025.
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Based on record review, the licensee did not comply with the above by not maintaining complete personnel records available for review which poses a potential risk to the health, safety, or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
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