414001146-12-5-2023-05-CC-LTMO-CY8SJU-20231205125543

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001146
Report Date: 12/05/2023
Date Signed: 12/05/2023 12:55:53 PM

Document Has Been Signed on 12/05/2023 12:55 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	CITY OF MENLO PARK-BELLE HAVEN CHILD DEV CENTER		FACILITY NUMBER:	414001146
ADMINISTRATOR:	STORMS, KIRA		FACILITY TYPE:	850
ADDRESS:	410 IVY DRIVE		TELEPHONE:	(650) 330-2270
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	96	CENSUS: 55	DATE:	12/05/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Director, Kira Storms		TIME COMPLETED:	01:20 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 December 5th, 2023 at approximately 9:05am, Licensing Program Analyst (LPA) Tapia-Mandujano arrived at the facility to conduct an unannounced, annual inspection. LPA met with Director, Kira Storms and explained the purpose of the inspection. Present in the facility are Director and nine staff caring and supervising a total of 55 preschool age children. All adults working in the facility are fingerprint cleared and associated to the facility. Facility is currently operating within teacher to child ratio on this date. Facility operated in four classrooms. There is a multi-purpose room that is used occasionally for events. Program operated Monday through Friday from 7:30am-4:45pm, year round with periodic days off throughout the year. Director guided LPA to conduct a health and safety inspection of the facility. LPA observed classrooms to be clean and equipped with age appropriate toys and materials. Storage for children's belongings are located inside the classrooms, labeled with each child's individual names. LPA observed facility has an installation of a fire alarm system inside each classroom as well as a fully charged, fire extinguishers located inside the kitchens. The classrooms have a smoke and carbon monoxide detector installed as well as emergency kits with first aid materials and emergency contact information in each classroom. Per Director, there are currently no children with prescribed medication. Facility has a plan in place to properly store Medication, inaccessible to enrolled children and will be maintained with proper documentation in each classroom. All poisons, cleaning solutions and hazardous materials are stored inaccessible to children in off limit areas or facility high shelves. Facility offers breakfast, lunch, and snacks through chefables. Menus are posted in each classroom. Water is available to children indoors and outdoors. Continued on Page 2..

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CITY OF MENLO PARK-BELLE HAVEN CHILD DEV CENTER	FACILITY NUMBER: 414001146
	VISIT DATE: 12/05/2023

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

Page 2 continued...

Outdoor area appears to be clean and orderly. There are a variety of outdoor equipment that are in good working condition. Children are signed in and out of facility with parents' signatures. Facility has license documentation and information properly posted and available for review in the entrance, as well as in each classroom for parents to review. There are no pools or bodies of water on the promises. Per Director, children will occasionally have water play with supervision and the water is emptied out after each use.

LPAs reviewed facility records that included 6 children's records and 6 staff records. LPAs observed children's records to be complete. Files that were reviewed showed that all staff have an up to date CPR & First Aid certificate. As well as all staff have up to date Mandated Reporter Certificate. Last emergency drill was conducted 10/2023. Emergency drills are conducted at least once every six months and are properly logged and documented.

Facility representative 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.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificate on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Continued on Page 3...

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CITY OF MENLO PARK-BELLE HAVEN CHILD DEV CENTER	FACILITY NUMBER: 414001146
	VISIT DATE: 12/05/2023

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

Page 3 continued...

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Facility representative 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.

Based on today's inspection, no deficiencies were observed, according to California Title 22, Health and Safety Code of Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Kira Storms.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 732-0619
LICENSING EVALUATOR NAME: Leslit Tapia-Mandujano	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3