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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700749
Report Date: 01/16/2025
Date Signed: 01/16/2025 04:05:57 PM

Document Has Been Signed on 01/16/2025 04:05 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:AMIGOS DE PALO ALTOFACILITY NUMBER:
435700749
ADMINISTRATOR/
DIRECTOR:
RODRIGUEZ, NOHORAFACILITY TYPE:
850
ADDRESS:1611 STANFORD AVENUETELEPHONE:
(650) 493-4300
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 8DATE:
01/16/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Nohora RodriguezTIME VISIT/
INSPECTION COMPLETED:
04:20 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 01/16/2025 at 1:15pm, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with Director Nohora Rodriguez for an unannounced annual inspection. Present during the inspection were director, five (5) fingerprint-cleared staff/volunteers, and eight (8) children in care. The facility is within ratio and in compliance with capacity regulations 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’s current hours of operation are Monday - Friday from 8:30am - 5:00pm.

Classrooms: This facility is licensed with two (2) classrooms, and both 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, wired smoke detectors, battery-operated carbon monoxide detectors, pull-down fire alarms, and fully charged 2A10BC 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. Bedding is provided by the facility and washed daily. Drinking water is accessible by children in the classrooms. The isolation area for when a child is sick is the front desk area.

Food Service Areas: Children bring all meals and snacks from home. Children eat in the covered outdoor area equipped with benches. Food prep area is clean, adequately equipped, and free from hazardous materials.

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 station is set-up and maintained according to Title 22 regulations.

Page 1 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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 6
Document Has Been Signed on 01/16/2025 04:05 PM - It Cannot Be Edited


Created By: Jialing Zhu On 01/16/2025 at 03:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AMIGOS DE PALO ALTO

FACILITY NUMBER: 435700749

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
(g) All personnel, including the licensee, administrator and volunteers, shall be in good health and shall be physically and mentally capable of performing assigned tasks.
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited aboveas 2 of 5 staff/volunteer files reviewed by LPA did not have TB test results, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2025
Plan of Correction
1
2
3
4
Director will obtain negative TB test results from the two staff/volunteers, then file in their files. Director will also email the TB test results to LPA at jialing.zhu@dss.ca.gov by 02/14/2025.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Jialing Zhu
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2025


LIC809 (FAS) - (06/04)
Page: 4 of 6
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: AMIGOS DE PALO ALTO
FACILITY NUMBER: 435700749
VISIT DATE: 01/16/2025
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
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 with mulch 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 five (5) staff/volunteer files. 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 08/26/2025. Mandated Reporter Training certificates were reviewed and current. Director’s Mandated Reporter training certificate expires on 09/07/2025. LPA reviewed six (6) children’s files. The center utilizes a paper sign-in/out system and is in compliance with sign in and out procedures. Fire/disaster drills are performed at least once every six months. The last drill was conducted on 12/13/2024. Per director, there are no firearms on the premises. All required documents, including a waiver for outdoor space usage, are posted in a publicly accessible area.

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. 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.

Page 2 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: AMIGOS DE PALO ALTO
FACILITY NUMBER: 435700749
VISIT DATE: 01/16/2025
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
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.

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. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/resources/child-care-centers/.

CCLD Information and Updates: 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.

One (1) Type B deficiency and two (2) Advisory Notes were issued during today’s inspection.

Type B Deficiency: 2 of 5 staff files reviewed by LPA did not have TB test results.

Advisory Note: 1 of 3 children's medication review by LPA was not labelled with the child's name; 1 of 6 children's files reviewed by LPA did not have signed LIC 701 Physician's Report including TB assessment and immunization records.

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 Nohora Rodriguez.

Page 3 of 3. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6