434415326-12-19-2024-52-CC-JZHU-DC4W49-20241219155712

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415326
Report Date: 12/19/2024
Date Signed: 12/19/2024 03:57:27 PM

Document Has Been Signed on 12/19/2024 03:57 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:	STANFORD ARBORETUM CHILDREN'S CENTER		FACILITY NUMBER:	434415326
ADMINISTRATOR/ DIRECTOR:	MARY ALLISON MONROE		FACILITY TYPE:	830
ADDRESS:	215 QUARRY ROAD		TELEPHONE:	(650) 725-6328
CITY:	STANFORD	STATE: CA	ZIP CODE:	94305
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 40	CENSUS: 28	DATE:	12/19/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:10 AM
MET WITH:	Allison Monroe		TIME VISIT/ INSPECTION COMPLETED:	04:10 PM

NARRATIVE

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On 12/19/2024 at 9:10am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with Director Mary Allison Monroe for an unannounced annual inspection. Present during the inspection were director, assistant director, 13 fingerprint-cleared staff, and 28 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 6:30am - 6:30pm. The facility shares a campus with a preschool license (facility #:434415327). The facility has an indoor and outdoor space for infants that are physically separate from space used by the preschool license.

Classrooms: This facility is licensed with four (4) classrooms, and all are currently in use. Classrooms were 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, wired smoke and carbon monoxide detectors, pull-down fire alarms, and fully charged 3A40BC fire extinguishers that are accessible throughout the facility. Fully stocked first-aid kits available in the classrooms. LPA inspected the napping equipment and observed them to be stored in a healthful manner. LPA observed there are cribs with the correct-sized mattresses and fitted sheets. Bedding is provided by the facility and washed weekly on-site. Drinking water is accessible by children in the classrooms. The isolation area for when a child is sick is the main office.

Food Service Areas: The facility provides AM/PM snacks to children in care. Children bring meals from home. LPA observed formula and breastmilk brought from home are properly labelled and stored. 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 menus are posted and were reviewed. Solid waste bins are equipped with tight fitting lids.

Page 1 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

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 6

Document Has Been Signed on 12/19/2024 03:57 PM - It Cannot Be Edited

Created By: Jialing Zhu On 12/19/2024 at 03:14 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: STANFORD ARBORETUM CHILDREN'S CENTER	FACILITY NUMBER: 434415326
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)(3)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: (3) Infants up to 12 months of age who are sleeping in a position other than on their back. 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 as one (1) infant under 12 months of age was sleeping on their stomach, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/20/2024
	Plan of Correction
1 2 3 4	LPA addressed Infant Safe Sleep requirements for infants under 12 months of age with assistant director. Infant was returned to sleep on their back immediately. LPA provided PIN 20-24-CCP to director that addresses recently approved Infant Safe Sleep Requirements in effect. Director reviewed PIN and will address this with staff. LPA determined this deficiency has been corrected at the end of today's inspection.

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

LICENSING EVALUATOR NAME:

Jialing Zhu

LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: STANFORD ARBORETUM CHILDREN'S CENTER	FACILITY NUMBER: 434415326
	VISIT DATE: 12/19/2024

NARRATIVE

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Bathrooms and Changing Stations: Facility has separate staff and child designated bathrooms. Toilets and faucets are in safe, sanitary, and operating condition. The children are able to reach the sinks, toilets, and supplies. LPA observed the changing stations to be set-up and maintained according to Title 22 regulations.

Outdoor Play Area: The outdoor play area is fully fenced. Areas used by children enrolled under the infant license are physically separated from the other outdoor areas with wooden and mesh gates. 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 is securely installed into the ground. The ground surrounding the play structure is sufficiently padded and in good condition for safety. Drinking water is accessible by children when outside. There are no pools or other bodies of water on premises.

Files and Record Keeping Review: LPA reviewed the facility roster and personnel report, and copies were obtained. All individuals subject to criminal record review have a clearance and/or exemption and have been associated to the facility. LPA reviewed four (4) staff files. Staff files were complete. Every classroom has at least one (1) fully qualified teacher. 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 04/18/2026. Mandated Reporter Training certificates were reviewed and current. Director’s Mandated Reporter training certificate expires on 10/03/2025. LPA reviewed six (6) children’s files. The center utilizes an electronic sign-in/out system and is in compliance with sign in and out procedures. Fire/disaster drills are performed at least once every six months. The last drill was a fire drill conducted on 11/02/2024. Per director, there are no firearms on the premises. All required documents 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/. Facility roster and personnel report 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.

Page 2 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: STANFORD ARBORETUM CHILDREN'S CENTER	FACILITY NUMBER: 434415326
	VISIT DATE: 12/19/2024

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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.

Incidental Medical Services (IMS): This facility does provide Incidental Medical Services (IMS). LPA observed medications are stored securely and are made inaccessible to children in care. All children’s medications were inspected to ensure that they are properly labeled and in compliance with expiration dates. 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) deficiency and two (2) Advisory Notes were issued during today’s inspection.

Type B Deficiency: LPA observed one (1) infant under 12 months of age sleeping on their stomach. LPA observed the required LIC 9227 Individual Infant Sleeping Plan was on file. Infant was returned to sleep on their back immediately.

Advisory Notes (please note the following are NOT deficiencies):

· 5 of 6 infant files reviewed by LPA had LIC 9227 on file but Section D was no filled in.

· 2 of 6 infant files reviewed by LPA did not have a current Infant Needs & Services Plan, which are required to be updated quarterly. They were last updated on 09/09/2024 and 09/11/2024.

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 Director Allison Monroe. Page 3 of 3. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024

LIC809 (FAS) - (06/04)

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