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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700717
Report Date: 08/01/2024
Date Signed: 08/01/2024 10:04:00 AM

Document Has Been Signed on 08/01/2024 10:04 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BUILDING KIDZ PALO ALTOFACILITY NUMBER:
435700717
ADMINISTRATOR/
DIRECTOR:		VIBHUTI PATELFACILITY TYPE:
830
ADDRESS:415 LAMBERT AVENUETELEPHONE:
(650) 673-3700
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 10DATE:
08/01/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Vibhuti PatelTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On 08/01/2024 at 9:00AM, Licensing Program Analyst (LPA) Jialing "Julianne" Zhu and Licensing Program Manager (LPM) Charles returned for an announced case management inspection. The purpose of this visit is to obtain signatures and to complete final printing of reports (LIC 9099s and LIC 9099Ds) created on 07/19/2024. Plan of Corrections (POCs) for the LIC 9099Ds were cleared and final printed.

On 07/19/2024, LPA Zhu and LPM Charles were at the facility to close a complaint and share findings with Executive Director Vibhuti Patel. LIC 9099s and LIC 9099Ds were completed and read to Executive Director Patel. However at around 11:30am, a consistency check was initiated on LPA Zhu's laptop so signatures were not obtained and final printing was not completed.

LIC 9213 Notice of Site Visit was given to Executive Director Patel. Appeal Rights were provided.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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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