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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400297
Report Date: 04/07/2025
Date Signed: 04/07/2025 11:08:17 AM

Document Has Been Signed on 04/07/2025 11:08 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:CHILDREN'S PRE-SCHOOL CENTER, THEFACILITY NUMBER:
434400297
ADMINISTRATOR/
DIRECTOR:		GRAVES, MARILYNFACILITY TYPE:
830
ADDRESS:4000 MIDDLEFIELD ROAD T-1TELEPHONE:
(650) 493-5770
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 22DATE:
04/07/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Marilyn GravesTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
NARRATIVE
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On 04/07/2025 at 9:20am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with Director Marilyn Graves for an unannounced annual continuation inspection. This inspection is a continuation of the annual inspection conducted on 04/03/2025. (See LIC 809 from 04/03/2025.) The information presented in this report is collected and observed from the initial annual inspection and the continuation inspection today. Present during the inspection were director, nine (9) fingerprint-cleared staff, and 22 infants in care. The facility is within ratio and in compliance with capacity regulations today. The facility is located on the premises of Cubberley Community Center and was toured to conduct a Health and Safety Inspection. The facility’s current hours of operation are Monday - Friday from 7:45am - 6:00pm. The facility shares a campus with a preschool license (facility #: 434400296). The facility has separate indoor and outdoor spaces for infants and preschool children to ensure there are no comingling.

Classrooms: This facility is licensed with 4 classrooms, and 3 are currently in use. Classrooms were inspected for age-appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces. The facility is equipped with telephone service, smoke and carbon monoxide detectors, pull-down fire alarms, and fully charged 3A40BC fire extinguishers that are accessible throughout the facility. Per director, the alarms are serviced annually by the Palo Alto Fire Department. Fully stocked first-aid kits are available in the classrooms. LPA inspected the napping equipment (sleep cots and bedding) and observed them to be stored in a healthful manner. Sheets are provided and washed daily at the facility. Additional blankets, when needed, are provided by the parents and returned home to be washed. Drinking water is accessible by children in the classrooms. The isolation area for when a child is sick is the director’s office.

Page 1 of 3. See LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CHILDREN'S PRE-SCHOOL CENTER, THE
FACILITY NUMBER: 434400297
VISIT DATE: 04/07/2025
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Infant Safe Sleep (ages 0-24 months): In the nap area that is currently used for young infants, LPA observed there are eight (8) cribs with the correct-sized mattresses and fitted sheets. Per director, infants are placed to sleep on their backs. 15-minute sleep checks are conducted and documented electronically. Swaddles, including sleep sacks, are not used.

Food Service Areas: The facility provides AM/PM snacks to children in care. Children bring meals from home. All center provided food items are properly labeled and stored separately from cleaning supplies. Food prep area is clean, adequately equipped, and free from hazardous materials. Snack menus are posted and were reviewed. Solid waste bins are equipped with tight fitting lids.

Bathrooms and Changing Stations: Facility has separate staff and child designated bathrooms. Toilets and faucets are in safe, sanitary, and operating condition. The children are able to reach the sinks, toilets, and supplies. Changing stations are set-up and maintained according to Title 22 regulations.

Outdoor Play Area: The outdoor play area is fully fenced. All equipment and surfaces are free from hazards. There is ample shade available. There are age-appropriate outdoor toys and materials for the children. The play structure is securely installed into the ground. The ground surrounding the play structure is sufficiently padded and in good condition for safety. Drinking water is accessible by children when outside. There are no pools or other bodies of water on premises.

Files and Record Keeping Review: LPA reviewed the facility roster and personnel report, and copies were obtained. All individuals subject to criminal record review have a clearance and/or exemption and have been associated to the facility. LPA reviewed three (3) staff files. Staff files were complete. Every classroom has a fully qualified teacher. At least one opening/closing staff member has a current Pediatric CPR/First-Aid Certification. Director’s CPR/First-Aid Certificate is current and expires on 03/16/2027. Mandated Reporter Training certificates were reviewed and current. Director’s Mandated Reporter training certificate expires on 07/08/2025. LPA reviewed six (6) children’s files. The center utilizes an electronic sign-in/out system and is in compliance with sign-in/out procedures. Fire/disaster drills are performed at least once every six months. The last drill was a fire drill conducted on 03/26/2025. Per director, there are no firearms on the premises. All required documents are posted in a publicly accessible area.

Page 2 of 3. See LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CHILDREN'S PRE-SCHOOL CENTER, THE
FACILITY NUMBER: 434400297
VISIT DATE: 04/07/2025
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Record Keeping and Reporting Requirements: Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Facility roster and personnel report must be properly maintained, and fire/disaster drills must be conducted at least every six (6) months and documented. Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within seven (7) business days. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov.

Criminal Record Clearance: Director 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.

Lead Testing: 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. LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Per director, this facility has not completed lead testing as the no taps are used for drinking. LPA observed 5-gallon water jugs and dispensers are available at the facility.

Incidental Medical Services (IMS): This facility does provide Incidental Medical Services (IMS). LPA observed medications are stored securely and are made inaccessible to children in care. All children’s medications were inspected to ensure that they are properly labeled and in compliance with expiration dates.

No deficiencies were cited during today's inspection. One (1) Advisory Note was issued during today’s inspection.

· 3 of 6 infant files reviewed by LPA on 04/03/2025 did not have up-to-date Infant Needs & Services Plans. Licensing regulates the plans are to be updated quarterly.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted, report was reviewed, and Appeal Rights were provided to Director Marilyn Graves. Page 3 of 3. End of Report.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025
LIC809 (FAS) - (06/04)
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