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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001721
Report Date: 05/17/2024
Date Signed: 05/17/2024 10:32:32 AM

Document Has Been Signed on 05/17/2024 10:32 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:CITY OF MENLO PARK-BELLE HAVEN SCHOOL-AGE CC PRGMFACILITY NUMBER:
414001721
ADMINISTRATOR/
DIRECTOR:		HOWARD, RONDELLFACILITY TYPE:
840
ADDRESS:100 TERMINAL AVE, BUILDING ATELEPHONE:
(650) 330-2245
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: 71TOTAL ENROLLED CHILDREN: 54CENSUS: 0DATE:
05/17/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Natalya Jones & Mayra MonjeTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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 May 17th, 2024 Licensing Program Analyst (LPA) Kassandra Medrano met with facility representatives Natalya Jones, Mayra Monje for the purpose of conducting a Case Management Inspection. On 5/13/2024 LPA's Medrano and Alvarado inspected and measured the indoor and outdoor spaces. On 05/15/2024 LPA Medrano received photo documentation of cubbies added to outdoor area. During todays inspection the encumbered space was measured and deducted from the outdoor capacity.
The following indoor measurements were taken by LPAs Medrano and Alvarado on 05/13/2024:
Classroom 108 “Youth Center”: (44.465 x 34.652= 1540.80) (14.0 x 8.6=120.40) subtract 10.479 x 2.500 (encumbered space) = 26.20= 2824.67= 47 children
Classroom 143 “Event Space”: 31.614 x 37.631= 1189.67= 33 children
TOTAL INDOOR SPACE: 2704.27 sq. ft. divided by 35 sq. ft. = 80 children
Although LPAs measured a capacity for 80 children, based on fire inspection conducted on 5/7/2024 fire inspector approved a temporary maximum occupancy for room 108 of 34 children in the space due to occupancy of facility. Based on measurements and occupancy granted by Menlo Park Fire facility will be licensed for 67 children until they correct the occupancy in Room 108.
The following outdoor measurements were taken by LPAs Medrano and Alvarado on 5/13/2024:
Playground: (63.773 x 54.6= 3482.01) + (50.11 x 37.7 = 1889.15) + (27.5 x 30.689=843.95) = 6215.10 subtract 1.9 x 16.4 (encumbered space measured today )= 31.16= 6183.94
TOTAL OUTDOOR SPACE: 6183.94 sq. ft. divided by 75 sq. ft. = 82 children

LPA spoke to facility representatives about play structure as its intended use is for children 5 and up, and their program now includes TK children. Facility representatives understand that children under 5 cannot use the structure.
During inspection, LPA observed 62 cubbies, which are enough for the total enrolled children. Facility is in the process of dividing cubbies. LPA received all documents requested during last inspection.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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 2
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 SCHOOL-AGE CC PRGM
FACILITY NUMBER: 414001721
VISIT DATE: 05/17/2024
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 that a license for 67 school age children will be granted pending the receipt of the following items:
1) Approved waiver from Community Care Licensing for a shared bathroom space.
2) Approval from Community Care Licensing Management.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representatives, Mayra Monje and Natayla Jones.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2