434400134-10-3-2024-52-CC-JZHU-D9PUXV-20241003155857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400134
Report Date: 10/03/2024
Date Signed: 10/03/2024 03:59:42 PM

Document Has Been Signed on 10/03/2024 03:59 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	LILLIPUT INFANT-TODDLER CENTER		FACILITY NUMBER:	434400134
ADMINISTRATOR:	HELER, VICKY		FACILITY TYPE:	830
ADDRESS:	3789 PARK BLVD.		TELEPHONE:	(650) 856-7407
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY:	9	CENSUS: 7	DATE:	10/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Andrea Real Heler		TIME COMPLETED:	04:15 PM

NARRATIVE

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On 10/03/2024 at 12:45pm, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with Co-Director Andrea Real Heler for an unannounced annual inspection. Present during the inspection were director, two (2) fingerprint-cleared staff, and seven (7) infants in care. The facility is within ratio and in compliance with capacity regulations today. Upon arrival, LPA provided director a copy of the Entrance Checklist (LIC 125). The facility was toured to conduct a Health and Safety Inspection. The facility’s current hours of operation are Monday - Friday from 8:00am - 5:00pm. The facility shares a campus with a preschool license (license #434413389).

Classrooms: This facility has one (1) infant classroom. The classroom was inspected for age-appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces. The facility is equipped with telephone service, a fully functional smoke detector and carbon monoxide detector, a fully charged 3A40BC fire extinguisher, and a fully stocked first-aid kit available in the classroom. LPA observed there are eight (8) cribs with the correct-sized mattresses and fitted sheets provided by the facility. Drinking water is accessible by children in the classroom. The isolation area for when a child is sick is the outdoor deck, and infant will be supervised by a staff member.

Food Service Areas: The facility provides AM/PM snacks, and meals are brought from home. All center provided food items are properly labeled and stored separately from cleaning supplies. Food prep area is clean, adequately equipped, and free from hazardous materials. Snack menu is posted and reviewed. Solid waste bins are equipped with tight fitting lids.

Bathroom and Changing Station: Facility has separate staff and child designated bathrooms. Toilets and faucets are in safe, sanitary, and operating condition. LPA observed the changing station to be set-up and maintained according to Title 22 regulations.

Page 1 of 3. See LIC 809C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Jialing Zhu	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

Document Has Been Signed on 10/03/2024 03:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LILLIPUT INFANT-TODDLER CENTER	FACILITY NUMBER: 434400134
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.3(a)

Modifications to Infant Needs and Services Plan

(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on director interview and record review, the licensee did not comply with the section cited above as 6 of 8 Infant Needs and Services Plan was last updated more than 3 months ago, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/04/2024
	Plan of Correction
1 2 3 4	Director will obtain updated Infant Needs and Services Plan for all infants in care. Director will ensure all plans will be updated quarterly. Director will email at least 3 updated plans to LPA at jialing.zhu@dss.ca.gov by 11/04/2024.

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.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Jialing Zhu	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LILLIPUT INFANT-TODDLER CENTER	FACILITY NUMBER: 434400134
	VISIT DATE: 10/03/2024

NARRATIVE

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Outdoor Play Area: The facility holds a waiver for infants and preschool children to use the same outdoor space as long as they are scheduled to be outside at different times. There is a fully fenced deck outside the classroom specifically for infant use. The outdoor play area is fenced. All equipment and surfaces are free from hazards. There is ample shade available. There are age-appropriate outdoor toys and materials for the children. The play structure and infant swing sets are securely installed into the ground. The ground is sufficiently padded with rubber, turf, and mulch and in good condition for safety. There are no pools or similar bodies of water on premises.

Files and Record Keeping Review: LPA reviewed the facility roster and personnel report. All individuals subject to criminal record review have a clearance and/or exemption and have been associated to the facility. LPA reviewed three (3) staff files. At least one opening/closing staff member has a current Pediatric CPR/First-Aid Certification. Director’s CPR/First-Aid Certificate is current and expires on 10/19/2025. Mandated Reporter Training certificates were reviewed and current. Director’s Mandated Reporter training certificate expires on 12/31/2024. LPA reviewed eight (8) children’s files. The facility utilizes a paper sign-in/out system and is in compliance with sign in and out procedures. The last fire/disaster drill was an earthquake drill conducted on 03/18/2024. Per director, there are no firearms on the premises. All required documents, including the menu are posted in a publicly accessible area.

Record Keeping and Reporting Requirements: Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Personnel and facility roster must be properly maintained, and fire/disaster drills must be conducted at least every six (6) months and documented. Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within seven (7) business days. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov.

Criminal Record Clearance: Director was 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 for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Page 2 of 3. See LIC 809C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Jialing Zhu	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LILLIPUT INFANT-TODDLER CENTER	FACILITY NUMBER: 434400134
	VISIT DATE: 10/03/2024

NARRATIVE

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Lead Testing: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS): This facility does not provide Incidental Medical Services (IMS). For IMS information see PIN 22-02-CCP. 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/resources/child-care-centers/.

CCLD Information and Updates: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

One (1) Type B deficiency and two (2) Advisory Notes were issued during today’s inspection. Note that Advisory Notes are not citations.

Type B Deficiency:

· 6 of 8 Infant Needs and Services Plan was last updated more than 3 months ago. Licensing regulations require these plans to be updated quarterly.

Advisory Notes (Technical Violations):

· The last drill was an earthquake drill conducted on 03/18/2024. Licensing regulations require a fire/disaster drill to be conducted at least once every 6 months.

· 6 of 8 children's files reviewed by LPA had immunization records that were not up-to-date.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted, report was reviewed, and Appeal Rights were provided to Co-Director Andrea Real Heler.

Page 4 of 4. End of Report.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Jialing Zhu	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4