435700368-1-31-2025-52-CC-JZHU-DDFUC7-20250131142728

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700368
Report Date: 01/31/2025
Date Signed: 01/31/2025 02:27:42 PM

Document Has Been Signed on 01/31/2025 02:27 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:	LEVIN, DEVORAH		FACILITY NUMBER:	435700368
ADMINISTRATOR/ DIRECTOR:	LEVIN, DEVORAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 561-6013
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	01/31/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Devorah Levin		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

NARRATIVE

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On 01/31/2025 at 11:30am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with licensee Devorah Levin for an unannounced annual inspection. Upon arrival, LPA provided licensee a copy of the Entrance Checklist (LIC 126). The facility is a two-story home. Also residing in the home is licensee’s spouse and five (5) children. The home was toured to conduct a Health and Safety Inspection in the on-limits areas only. The facility’s current hours of operation are Monday - Friday from 8:00am - 5:00pm.

Ratio/Capacity: The facility operates as a large Family Child Care Home licensed with a capacity of 14 children. At the time of the inspection, there were 9 children (3 infants and 6 preschool-age) in care, 2 of which are licensee’s children. Three (3) fingerprint-cleared volunteers were present. The licensee is within ratio and in compliance with capacity regulations today.

On-limit Areas (accessible by children in care): The on-limit areas are the living room/dining area, play room, bedroom, two bathrooms (1^st floor), and backyard. The isolation area is the bedroom. When a child shows signs of illness, he/she will be separated from other children here. The inside of the home is observed to be clean and orderly, with central heating and ventilation for safety and comfort. LPA observed there are ample safe and age-appropriate toys, play equipment and materials. LPA observed one cleaning spray on top of the sink, and one cleaning product under the cabinet sink which is not locked or secured. Licensee removed the cleaning products and made them inaccessible to children during the inspection.

The outdoor play area is the backyard, which is completely fenced with visual supervision. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of age-appropriate toys and activities available for children, and they are in good condition. There is ample shade available, and gates are locked at all times while children are in the backyard. There are two (2) play structures equipped with slides and swings. LPA observed one swing set is not stable. LPA advised licensee the unstable swing set cannot be used until properly secured. The ground around the play structures is sufficiently padded with turf. There are no pools, hot tubs, or similar bodies of water on premises. Page 1 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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 01/31/2025 02:27 PM - It Cannot Be Edited

Created By: Jialing Zhu On 01/31/2025 at 01:15 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: LEVIN, DEVORAH	FACILITY NUMBER: 435700368
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(5)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above as one infant was sleeping in a room with the door closed, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/03/2025
	Plan of Correction
1 2 3 4	The door to the room was opened and remained open for the during when the infant was sleeping in the room. Per licensee, she will reconfigure the placement of the cribs so that the crib will be placed against the wall and can be viewed from outside the room without moving the opened door. LPA provided a copy of Infant Safe Sleep Regulations (102425) as a resource for licensee to review.

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: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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: LEVIN, DEVORAH	FACILITY NUMBER: 435700368
	VISIT DATE: 01/31/2025

NARRATIVE

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Off-limit Areas (not accessible by children in care): The off-limit areas are the kitchen and the entire second floor, which are inaccessible by closed and/or locked doors and visual supervision. Stairs in the home are made inaccessible to children with a sliding screen. LPA advised licensee she must contact Licensing for an inspection prior to changing an OFF-Limit area to ON-Limit.

Child Care Operations: Licensee provides snacks and meals for the children. Cribs/play yards are in the facility with the correct size mattresses and fitted sheets. Children bring their own bedding. All food and bedding brought from children’s home are labeled with the children’s name and stored appropriately. LPA observed one infant was sleeping in a crib with the door closed.

Emergency Preparedness/Safety: Fully charged 3A40BC fire extinguishers are located by the entrance and kitchen. LPA observed one functional combination smoke and carbon monoxide detector in the play room. Fire/disaster drills are conducted at least once every six months, and the last drill was on 01/15/2025. The home is equipped with telephone service and first aid supplies. Per licensee, there are no firearms and no pets in the home.

Recordkeeping Review: All adults living in the home have obtained a criminal record clearance. Licensee’s Pediatric CPR/First Aid certification is current and expires on 07/29/2026. Licensee’s Mandated Reporter training for Child Care Providers and expires on 11/01/2026. The licensee is in compliance with the immunization laws.

A current facility roster is available for review. LPA reviewed five (5) children’s files and four (4) staff files.15-minute sleep check swere conducted and documented for all infants ages 0-24 months. The licensee rents the property. The facility does carry liability insurance. All required Licensing documents are posted by the entrance.

Licensee was reminded that California Law requires 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 624B). Any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Incidents must be reported within 24 hours by phone, fax, or email. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov.

Licensee was also reminded that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years.

Page 2 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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: LEVIN, DEVORAH	FACILITY NUMBER: 435700368
	VISIT DATE: 01/31/2025

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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 licensed Family Child Care Home. 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.

LPA discussed the safe sleep regulations with Licensee 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 licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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.

Type B Deficiency: One infant was sleeping in a room with the door closed. Licensing requires the door to be open at all times when an infant is sleeping inside.

Advisory Notes: Cleaning products not made inaccessible to children in care; 2 of 5 children's files reviewed by LPA did not have up-to-date immunization records.

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 licensee Devorah Levin. Page 3 of 3. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC809 (FAS) - (06/04)

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