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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415328
Report Date: 09/09/2022
Date Signed: 09/14/2022 10:16:53 AM


Document Has Been Signed on 09/14/2022 10:16 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:STANFORD MADERA GROVE CHILDREN'S CENTERFACILITY NUMBER:
434415328
ADMINISTRATOR:ZARCONE, SALLYFACILITY TYPE:
830
ADDRESS:751 OLMSTED ROADTELEPHONE:
(650) 721-6632
CITY:STANFORDSTATE: CAZIP CODE:
94305
CAPACITY:60CENSUS: 20DATE:
09/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nurten CelenTIME COMPLETED:
02:15 PM
NARRATIVE
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On 09/09/2022 at 9:00am, Licensing Program Analyst (LPA) Christina Uribe conducted an Unannounced Case Management Visit for the purpose of investigating a reported incident. LPA met with Interim Director, Nurten Celen, also present at the time of the inspection were 13 staff & 20 children. The facility is within ratio & capacity compliance today. The facility was toured to conduct a Health and Safety inspection. The facility currently operates 7:00am-6:30pm, Monday-Friday in the Chickadess, Wren, Duck, & Puffin classrooms.

Incident on 08/19/2022: Interim Director reported an incident which took place around 9:30am in which a child in care was left unattended in the play yard of the facility. During an interview, Interim Director explained that when the Wren classroom transitioned from outdoor to indoor, the teachers conducted a name-to-face check at the entrance into the classroom and noticed that one child was unaccounted for. A teacher immediately went back to the play yard and found the child inside of a play structure. It was estimated that the duration of time that the child was unaccounted for was at least 1 minute.

The Interim Director stated that normally the teachers line the children up at the gate out of the play area to account for each child and then walk through the gate and turn the corner that leads to the classroom door. Instead on this day the teachers lined the children up, went through the gate, turned the corner and then performed the name-to-face check at the door to the classroom. During a tour of the play area, LPA Uribe took photos for documentation of the play structure, play yard, and area of which the children are normally assembled to conduct the name-to-face check before proceeding through the gate and around the corner into the classroom.

Absence of supervision is a zero tolerance policy which results in the citation of a Type A Violation and the issuance of an immediate civil penalty of $500.00.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: STANFORD MADERA GROVE CHILDREN'S CENTER
FACILITY NUMBER: 434415328
VISIT DATE: 09/09/2022
NARRATIVE
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Following the incident, the Interim Director provided LPA Uribe proof of having held a staff meeting in which the incident was discussed, a plan was developed to ensure supervision at all times, and staff members within the Wren classroom had a one-on-one conference with the Interim Director.

Sign In & Out Procedure: During today's visit, LPA Uribe reviewed the sign in and out records for the day of the incident (08/19/22) and found several discrepancies. The facility has 3 separate records for attendance each day, one is maintained throughout the day by center staff known as the Child Supervision Record and the other two are sign in and out records which are utilized by the parents. One is an app called Curacubby which uses a QR code and PIN assigned to each family for sign in and out. Additionally, the other format is a paper form which the facility also has parents use to sign their child in and out each day. However, when comparing the staff maintained record and the two sign in and out records, there were discrepancies in the number of children in attendance on this day. 1 child was only signed in on the paper form, but was not signed out when picked up. 1 child was signed in on the app but was not signed out when picked up. 5 children were not signed in or out on either the paper form nor the app.

During an interview, the Interim Director stated that there have been some technical issues with the app which has been restricting some parents from signing their child in or out. Additionally, the reason why they also have the paper form is to know exactly which parent signed in or out. The app assigns each family one PIN and therefore when a child is dropped off or picked up, the app automatically generates one parent's name as the person signing in or out. Additionally, the paper form has not been consistently used by each parent each day when signing in or out, regardless of whether or not they were able to successfully electronically sign the child in or out. The facility had previously received a Technical Violation on 06/03/22 for this same issue. Due to the incomplete records for sign in and out, the facility is being issued a Type B Violation.

Interim Director: During interview, LPA Uribe found that the previous director resigned from the position in mid-July 2022. Since then the Assistant Director has assumed the title and responsibility of facility representative as the Interim Director. However, Community Care Licensing was not made aware of this change in the director position. The facility received a Technical Violation for this same issue on 04/01/22. This results in the issuance of a Type B Violation.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: STANFORD MADERA GROVE CHILDREN'S CENTER
FACILITY NUMBER: 434415328
VISIT DATE: 09/09/2022
NARRATIVE
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LPA Uribe informed Interim Director, Nurten Celen that this report dated 09/09/2022 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Uribe informed the Interim Diredctor to provide a copy of this licensing report dated 09/09/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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, report was reviewed, and appeal rights were given to the Interim Director, Nurten Celen.

Page 3 of 3 ***End of Report***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 09/14/2022 10:16 AM - 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: STANFORD MADERA GROVE CHILDREN'S CENTER
FACILITY NUMBER: 434415328

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2022
Section Cited

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101229(a)(1): Responsibility for Providing Care & Supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time. This regulation was not met as evidenced by:
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Based on interview, the facility did not comply with the section cited above as one child was left unattended on the play yard which posed an immediate health, safety or personal rights risk to persons in care.
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The written and signed statement will be emailed to LPA Uribe at christina.uribe@dss.ca.gov no later than the due date of 09/12/22 at 6:00pm.

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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5


Document Has Been Signed on 09/14/2022 10:16 AM - 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: STANFORD MADERA GROVE CHILDREN'S CENTER
FACILITY NUMBER: 434415328

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2022
Section Cited

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(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
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This requirement is not met as evidenced by:

Based on record review, the facility did not comply with the section cited above as several children were not appropriately signed in or out which poses a potential health, safety, or personal rights risk to chidlren in care.
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This plan of correction will be emailed to christina.uribe@dss.ca.gov no later than the due date of 10/10/2022.
Type B
10/10/2022
Section Cited

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(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
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This requirement is not met as evidenced by:

Based on record review & interview, the facility did not comply with the section cited above as there was a change in director which was not reported to CCLD which poses a potential health, safety, or personal rights risk to 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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022
LIC809 (FAS) - (06/04)
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