<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700776
Report Date: 10/03/2024
Date Signed: 10/03/2024 02:52:04 PM

Document Has Been Signed on 10/03/2024 02:52 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:CHILDREN'S HOUSE OF LOS ALTOSFACILITY NUMBER:
435700776
ADMINISTRATOR/
DIRECTOR:		ELLA MAYONFACILITY TYPE:
860
ADDRESS:1120 ROSE AVETELEPHONE:
(650) 968-9052
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 54DATE:
10/03/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:36 AM
MET WITH:Ella MayonTIME VISIT/
INSPECTION COMPLETED:
03:06 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On Thursday, October 3, 2024, at 11:36 AM, Licensing Program Analyst, (LPA) Caroline Colson met with Applicant Ella Mayon, Courtney Mayon, daughter and center director, for a Change of Ownership prelicensing inspection. The applicant requests 105 school age children from TK to 13 years of age. A health and safety inspection in all areas accessible to children was conducted. There are 54 school age children. The program will operate Monday through Friday from 7:30 AM to 6:00 PM.

Physical Plant: The facility is located on the Springer Elementary School in two large portables which are divided into three classrooms. There are separate restrooms for children and staff. There is adequate heating, lighting, and ventilation. There are no cleaning solutions, chemicals, or other hazards accessible to children. Per Applicant, there are no weapons at the facility.

Classrooms: Furniture and equipment are age appropriate and in good repair. There are separate storage areas for children’s belongings. Drinking water will be provided and distributed in labeled water bottles and in uncontaminated water pitchers for all children. There are five first aid kits. Applicant will compile an emergency disaster bag. The facility provides one snack in the afternoon. The menu is posted for review. Food is available and in quantity necessary to meet the needs of the children in care.

Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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 5
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: CHILDREN'S HOUSE OF LOS ALTOS
FACILITY NUMBER: 435700776
VISIT DATE: 10/03/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Restrooms: All sinks and toilets are operable. There is soap, toilet paper and paper towels for sanitary use.

There are a total of seven (7) toilets and eleven (11) sinks for the children, and a separate restroom for the staff located near the director's office. Staff bathroom and director's office are the isolation areas.

Outdoor Activity Space:
There is two outdoor areas on the property. The outdoor play areas are fenced with a chain link fence and building wall that are at least four feet tall. There is enough age-appropriate equipment and toys. There is cushioning material underneath all outdoor climbing equipment. There is a shaded area for the younger children's yard that includes coverage from three (3) table umbrellas. The second yard for the older school children do have a large tarp as the shaded area. There are no bodies of water on the premises. Climbing structures and slides are safe and in good condition. Playground is free of debris and other hazards. Children have access to drinking water and will use their own labeled water bottles outside.

Emergency Preparedness/Safety: Emergency Disaster Plan is dated and posted for review. The facility utilizes a land line telephone and cell phones. Fire Clearance was received.

Sign in/Sign out: Applicant stated that all staff and parents will be providing a full legal signature, time of arrival and departure when a child is being picked up and dropped off.

Licensee 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.

Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: CHILDREN'S HOUSE OF LOS ALTOS
FACILITY NUMBER: 435700776
VISIT DATE: 10/03/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure. LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Applicant 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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and ADA, available at http://www.ada.gov/childqanda.htm

LPA reviewed with Applicant the LIC 311 A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: CHILDREN'S HOUSE OF LOS ALTOS
FACILITY NUMBER: 435700776
VISIT DATE: 10/03/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA discussed 100% supervision is always required in all areas that children have access to including the bathroom. Personal Rights, inspection authority, reporting requirements, maintaining buildings and grounds was reviewed. Staff Qualifications, Staff to Children’s ratios and Capacity was explained to ensure compliance. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: CHILDREN'S HOUSE OF LOS ALTOS
FACILITY NUMBER: 435700776
VISIT DATE: 10/03/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Exit interview was conducted with Applicant, Ella Mayon.

The following items are required before a license will be issued:

1. Applicant will need to purchase two trash containers with lids.
2. Applicant will need to purchase a smoke detector for Classroom 3.
3. Applicant will need to purchase 5 antiseptic solutions and 5 tweezers.
4. Applicant will need to submit an updated LIC 200 A to update age range.
5. Applicant will need to have a water table cover for the second water table.
6. Applicant's immunization records will need to be reviewed.
7. Updated Parent Handbook will need to be reviewed.
8. Update Sign In and Sign Out sheets to include full signatures.
9. Contact fire department about maximum capacity per room.
10. Applicant will need to create a plan to transport children to the relocation site.
11. Licensing Program Manager (LPM) final file review
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5