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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700427
Report Date: 07/03/2025
Date Signed: 07/03/2025 03:05:58 PM

Document Has Been Signed on 07/03/2025 03:05 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:LEVIN, DEVORAHFACILITY NUMBER:
435700427
ADMINISTRATOR/
DIRECTOR:		DEVORAH LEVINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 561-6013
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
07/03/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Devorah LevinTIME VISIT/
INSPECTION COMPLETED:
03:20 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 07/03/2025 at 1:30pm, Licensing Program Analyst (LPA) Jialing "Julianne" Zhu, met with applicant Devorah Levin for an announced change of location prelicensing inspection for a Large Family Child Care Home. Fire clearance has been granted by the Palo Alto Fire Department on 06/19/2025 for a capacity of 14 children with no restrictions or special conditions noted. Present during the inspection were applicant and one (1) minor child. A contractor was also present to work on renovations of the outdoor space. The applicant lives in the home with fingerprint-cleared spouse and six (6) minor children. A Prelicensing Entrance Checklist (LIC 9280) was provided to the applicant. The home was toured to conduct a Health and Safety Inspection. The facility’s intended hours of operation are Monday-Friday from 8:00am to 6:00pm.

The home is a single-story home rented by the Applicant. The home has three (3) bedrooms, two (2) bathrooms, living room, dining area, kitchen, breakfast nook, attached garage, front yard, and backyard.

The on-limit areas are the three (3) bedrooms, two (2) bathrooms, living room, dining area, kitchen, breakfast nook, front yard, and backyard. The isolation area is the breakfast nook. When a child shows signs of illness, he/she will be separated from other children here. There is a fireplace in the living room, which has been made inaccessible to children with a screen and bookshelf.

The outdoor play areas the front yard and backyard. However, renovations were still in progress of today’s inspection. LPA will return to inspect the outdoor play areas at a later date before license can be approved.

The off-limit area is the garage, which will be inaccessible by closed and/or locked doors and visual supervision.

Page 1 of 4. See LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2025
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
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)
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: LEVIN, DEVORAH
FACILITY NUMBER: 435700427
VISIT DATE: 07/03/2025
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
The inside of the home is observed to be clean and orderly, with central heating/cooling and ventilation for safety and comfort. LPA observed there are ample safe and age-appropriate toys, play equipment and materials. All toxins, cleaning products, and hazardous materials have been made inaccessible to children. There are no firearms and no pets in the home.

There is a fully charged 3A40BC fire extinguisher in living room. LPA observed one combination (1) smoke and carbon monoxide detector in the living room. The home is equipped with telephone service and first aid supplies.

LPA observed at least four (4) portable cribs in the facility with the correct size mattresses and fitted sheets. Sleep cots are also available. Children will be bringing their own bedding and sent home to be washed weekly. Applicant stated that she will provide all food (meals and snacks) for the children. LPA informed applicant that all beddings and food brought from children’s home shall be labeled with the children’s name and stored appropriately. Applicant will not provide transportation services.

The applicant completed the Health and Safety training. The applicant’s Pediatric CPR/First Aid certification is current and expires on 07/29/2026. The applicant has completed the Mandated Reporter (Child Care Providers) training and expires on 11/10/2026. The applicant is in compliance with the immunization laws. All adults living in the home have obtained a criminal record clearance.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Applicant understands the family child care home must have a current roster of children who are provided care in the facility, and this roster shall be available to the licensing agency upon request. Applicant also understands that fire/disaster drills must be conducted every six (6) months and documented. Applicant may or may not have liability insurance but is aware parents must sign an affidavit (LIC 282) that states the parents has been informed the facility does not carry liability insurance.

Applicant was reminded that California Law requires 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 624B). Any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Incidents must be reported within 24 hours by phone, fax, or email. LPA informed the Applicant that all forms can be downloaded at www.ccld.ca.gov.

Page 2 of 4. See LIC 809C.

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

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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: LEVIN, DEVORAH
FACILITY NUMBER: 435700427
VISIT DATE: 07/03/2025
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
Applicant was also reminded that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Applicant was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 licensed Family Child Care Home. 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.

The applicant has obtained a signed Property Owner/Landlord Consent form (LIC9149). With this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 14 children when following the maximum capacity ratio. LPA explained to applicant about ratio and capacity regulations she will be operating by. Applicant understands that her own children under 10 years of age will count in her ratio when they are present during operating hours.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage 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.

Applicant was informed of the MyChildCarePlan.org site, 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.

Page 3 of 4. See LIC 809C.

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

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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: LEVIN, DEVORAH
FACILITY NUMBER: 435700427
VISIT DATE: 07/03/2025
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
On this date, 06/04/2025 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

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.

As of today’s inspection, the application remains PENDING due to unfinished renovation of the outdoor play areas. LPA is scheduled to return on 07/17/2025 to inspect the outdoor play areas after renovations have been completed and are set up for childcare. Applicant will notify LPA if renovations are delayed and need to reschedule to a later date.

Exit interview was conducted, and report was reviewed with the applicant Devorah Levin.

Page 4 of 4. End of Report.

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

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5