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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700746
Report Date: 08/06/2021
Date Signed: 08/06/2021 03:34:22 PM

Document Has Been Signed on 08/06/2021 03:34 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:STANFORD WEST CHILDREN'S CENTERFACILITY NUMBER:
435700746
ADMINISTRATOR:LARSEN, NATHALIEFACILITY TYPE:
830
ADDRESS:625 CLARK WAYTELEPHONE:
(415) 994-8040
CITY:PALO ALTOSTATE: CAZIP CODE:
94304
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/06/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Nathalie LarsenTIME COMPLETED:
03:40 PM
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A Prelicensing Visit was conducted today by Licensing Program Analyst (LPA), Melanie Otsuji. LPA met with Applicant, Nathalie Larsen. The applicant has submitted an application for an INFANT license. A health and safety inspection was conducted inside and outside. The infant program will operate in 2 classrooms (Pond "Rm 128" and Shore "Rm 124"). Also on site is a Preschool Component operating out of 5 classrooms. Operating Monday through Friday from 7:00AM - 6:00PM. The measurements are as follows:

INDOORS: 992.77 square feet = 28 children
OUTDOORS: 4327.95 square feet = 58 children

Classrooms are equipped with varied age appropriate materials and equipment. The diaper changing tables are within arms reach of a sink. There is a separate crib area with up to 11 cribs for infants. There are 2 sinks and 1 toilet available for children. The office and staff bathroom will serve as isolation area for ill children. There is a total of 1 play yard for the infant aged children to utilize. The yard is fenced in all around. Yards with high climbing equipment are cushioned with poured rubber and/or artificial grass. Canopies and/or trees provide sufficient shade in all play yards. AM/PM snacks are served with lunch brought from home. There are food preparation areas in each classroom. Cabinets with cleaners are locked and/or inaccessible to prevent access to children. Facility utilizes electronic sign in and out. The system allows for a unique identifier and records the date and time of day.

This facility plans to provide Individual Medical Services – IMS. When any changes to IMS is made a new plan 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)/ (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
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2021
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 WEST CHILDREN'S CENTER
FACILITY NUMBER: 435700746
VISIT DATE: 08/06/2021
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Javanni Austin-Brown is a fully-qualified infant/preschool director. There is a working telephone on site. The center has obtained an approved fire safety inspection on 8/4/2021 for 24 children.

Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair. A license for 24 infant aged children operating out of 2 rooms (Pond and Shore) is recommended with an effective date of 8/6/2021.

An exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
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