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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415329
Report Date: 09/12/2024
Date Signed: 09/12/2024 04:14:53 PM

Document Has Been Signed on 09/12/2024 04:14 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:STANFORD MADERA GROVE CHILDREN'S CENTERFACILITY NUMBER:
434415329
ADMINISTRATOR/
DIRECTOR:		ZARCONE, SALLYFACILITY TYPE:
850
ADDRESS:751 OLMSTED ROADTELEPHONE:
(650) 721-6632
CITY:STANFORDSTATE: CAZIP CODE:
94305
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 86DATE:
09/12/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Kimberly KostepenTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 09/12/2024 at 9:10am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with Director Kimberly Kostepen for an unannounced annual inspection. Present during the inspection were director, 16 fingerprint-cleared staff, and 86 children in care. The facility is within ratio today. Upon arrival, LPA provided director a copy of the Entrance Checklist (LIC 125). The facility was toured to conduct a Health and Safety Inspection. The facility shares a campus with an infant license (434415328).

During the course of today's inspection, LPA reviewed LIC 9040 Facility Roster, LIC 500 Personnel Report, 7 children's files and 7 staff files.

Due to time constraints, LPA was not able to complete the annual inspection today. LPA will return on another day to complete today's inspection. No deficiencies were cited today.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Director Kimberly Kostepen. LPA provided director a copy of the Appeal Rights.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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