414004888-5-22-2025-05-CC-KKRN-DGWM5Y-20250522091908

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004888
Report Date: 05/21/2025
Date Signed: 05/22/2025 09:21:50 AM

Document Has Been Signed on 05/22/2025 09:21 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:	ALPHA KIDS ACADEMY LLC-INFANT		FACILITY NUMBER:	414004888
ADMINISTRATOR/ DIRECTOR:	SHTERN, NATELLA		FACILITY TYPE:	830
ADDRESS:	201 RAVENSWOOD AVENUE		TELEPHONE:	(415) 664-8080
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 6	DATE:	05/21/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:18 AM
MET WITH:	June Keo		TIME VISIT/ INSPECTION COMPLETED:	06:30 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 May 21, 2025 at approximately 8:00AM, Licensing Program Analyst (LPA) Katie Krenn conducted an unannounced annual visit. During today’s visit, LPA met with Director, June Keo and explained the purpose of the visit to her. During today's inspection LPA observed six infants and three teachers. LPA reviewed the sign in sheet where parents sign their children in and out of the facility. LPA confirmed that all three teachers present had obtained criminal record clearances and were associated with the facility. The facility remains within its capacity limits and meets the required ratios for today’s visit. The facilities hours of operation are Monday - Friday from 7:30AM - 5:30PM. The facility currently does not take drop-ins. LPA observed that all required documents: such as the facility license, notification of parents’ rights, car seat laws, personal rights, earthquake checklist, and emergency disaster plan, were displayed in a prominent place. The postings posted on a window, which made them backlit and partially covered by blinds. LPA discussed options for improving visibility. Director said she understood. LPA observed that the license numbers were not included on the signs out front. LPA discussed options for adding the numbers to the existing signs. Director said she understood and would add the license numbers to the signs. continued on page 2

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 06/17/2025 08:45 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/06/2025 02:25 PM

Created By: Katie Krenn On 05/21/2025 at 02:32 PM

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALPHA KIDS ACADEMY LLC-INFANT	FACILITY NUMBER: 414004888
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(a)

Child's Records

(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/30/2025
	Plan of Correction
1 2 3 4	Ensure that all children's records have all the necessary forms. Send scanned copy of LIC 613A Personal Rights, LIC 995 Notification of Parents’ Rights, LIC 627 Consent for Emergency Medical Treatment, and updated vaccination records.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Daniel J Oquendo
NAME OF LICENSING PROGRAM MANAGER:

	Katie Krenn
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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: ALPHA KIDS ACADEMY LLC-INFANT	FACILITY NUMBER: 414004888
	VISIT DATE: 05/21/2025

NARRATIVE

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The LPA inspected the indoor and outdoor areas for health and safety hazards. The facility was clean, safe, and well-maintained. Disinfectants, cleaning solutions, and poisons were securely stored out of children's reach, and all accessible cabinets and drawers in the classrooms were free of hazardous materials.

LPA observed that the infant classroom had age-appropriate toys, furniture, educational materials, and designated storage space for each child, which included hooks and cubby space, all of which were clearly labeled for each child. LPA did not observe any accessible electrical outlets. The facility had a changing table near a sink.

The outdoor playground has a fence. The play equipment is in good condition and does not have sharp, loose, or pointed parts. The areas around and under climbing equipment and slides are cushioned with artificial grass. There are no pools, spas, or bodies of water on the property. Each child has their own water bottle which is filled at the facility from purchased distilled water jugs. The water bottles are carried in a caddy so they can be brought outside during outdoor play and accessible to the children.

The infant program does not currently provide lunch for the children. The families provide lunches, snacks, and milk or formula for their children. LPA observed that each child had lunch boxes in their designated storage space, with perishables labeled and stored in the fridge.

The facility offers cribs, cots, and play yards for children to rest or nap. Per the director, each child has their own. Per the director, bedding is provided from home and goes home with children on Fridays for laundering.

LPA reviewed the files of five children. LPA observed that a child needed to have an update in their vaccination records. LPA reminded the director that it is important to remind parents to submit updated vaccination records. LPA found that a child was missing forms that included consent for medical treatment, parent's rights, and personal rights. Another child's forms were missing parent signature. LPA reviewed these findings with the director. The director confirmed that she would complete the files.

LPA reviewed four staff files and confirmed that all necessary forms were complete and in order. LPA verified that three staff members held current Pediatric First Aid and CPR certifications, expiring in August 2025.
continued on page 3

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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: ALPHA KIDS ACADEMY LLC-INFANT	FACILITY NUMBER: 414004888
	VISIT DATE: 05/21/2025

NARRATIVE

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During a review of the staff transcripts, LPA found that there was a fully qualified teacher and two aides in the infant classroom. All the teachers had current Mandated Reporter Training. LPA found that one aide did not have complete vaccination records available for review. The aide was informed that they needed to obtain verification of immunity to or vaccination for the measles. Aide confirmed that they would get tested tomorrow and the director would provide verification by 05/27/2025.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/‌inspection-process.

Director was 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.

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA issued one type B citation during today's visit.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the director, June Keo.

NAME OF LICENSING PROGRAM MANAGER: Daniel J Oquendo
NAME OF LICENSING PROGRAM ANALYST: Katie Krenn
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC809 (FAS) - (06/04)

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