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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700793
Report Date: 01/14/2026
Date Signed: 01/14/2026 03:41:50 PM

Document Has Been Signed on 01/14/2026 03:41 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:
435700793
ADMINISTRATOR/
DIRECTOR:		KOSTEPEN, KIMBERLYFACILITY TYPE:
860
ADDRESS:751 OLMSTED ROADTELEPHONE:
6507216632
CITY:STANFORDSTATE: CAZIP CODE:
94305
CAPACITY: 204TOTAL ENROLLED CHILDREN: 186CENSUS: 140DATE:
01/14/2026
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Kimberly KostepanTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 01/14/2026, Licensing Program Analyst (LPA), Brindha Govindasamy conducted an announced pre-licensing inspection and met with Kimberly Kostepen, Center Director. The purpose of the visit was an announced pre-licensing inspection to add a toddler component. The facility has an existing preschool program facility # 434415329 with a capacity of 144 preschool children and an infant program # 434415328 with a capacity of 60 infants which will be converted to a single license upon completion of the inspection process. Applicant is requesting to be licensed for total 204 children from which 60 infants (ages 02 months to 24 months ) located on the lower level of building A(Acorn) and B (Mulberry) 32 toddlers (ages 18 months to 36 months) and 112 preschoolers (ages 24 months to 60 months) on the upper and lower level of building A(Acorn) and B(Mulberry). Hours of operation will be Monday to Friday 7:00AM to 6:30PM. Fire clearance was granted on 05/01/2025.

Infant Classrooms measurements are:

The Indoor total measurements contain a total of { 2157.352} square feet, which will accommodate Applicant's request for 60 infants.

Infant Outdoor Play measurements are:

Outdoor total measurements contain a total of {4503.052} square feet, which will accommodate Applicant’s request for 60 infants.

Preschool Classrooms measurements are:


The Indoor total measurements contain a total of {4007.02 } square feet, which will accommodate Applicant's request for 112 preschool children.

Preschool Outdoor Play measurements are:

Outdoor total measurements contain a total of { 8540.85 } square feet, which will accommodate Applicant’s request for 112 preschool children.

Toddler Classroom measurements are:

The Indoor total measurements contain a total of { 1132.53} square feet, which will accommodate Applicant's request for 32 toddlers.

Toddler Outdoor Play measurements are:

Outdoor total measurements contain a total of { 7971.77 } square feet, which will accommodate Applicant’s request for 32 toddlers.



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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Brindha Govindasamy
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2026
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)
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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: STANFORD MADERA GROVE CHILDREN'S CENTER
FACILITY NUMBER: 435700793
VISIT DATE: 01/14/2026
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All indoor and outdoor activity space utilized for the toddler was inspected today. LPA informed director that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. No co-mingling is allowed during indoor and outdoor activities. A fully equipped first aid kit is located in all classrooms. There is an operational carbon monoxide detector on site. All required licensing documents were observed posted. LPA continued to tour the facility and measured indoor and outdoor activity space of the toddler area. Outdoor area for preschool area was remeasured. All components have separate outdoor activity space. Measurements for the infants indoor and outdoor will remain the same as the previous pre licensing. LPA confirmed with director that there were no firearms or weapons at the facility and observed no bodies of water or heaters.

The facility was observed to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. A comfortable temperature for children should be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. There are sufficient chairs, tables, cubbies, toilets, sinks, urinals, cots, available for infants, preschool and toddler children.

The facility currently has a fully fenced playground and separate area for infants, preschool and toddlers. Fencing is at least four feet high. Shade is provided via trees, and canopies. There are sufficient outdoor age-appropriate toys and play equipment available on the playgrounds. There are age-appropriate climbing structures on the preschool yard. There is adequate cushioning in fall zones. Children take their own water bottle during outdoor activity time. LPA observed all hazardous items on the playground(s) to be inaccessible to children. Applicant was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.



LPA reviewed with Applicants Section 101216.4 Preschool Program with Toddler Component. Toddlers may be enrolled into the program starting at age 18 months to a maximum of 36 months. LPA advised that children enrolled into the toddler program cannot be placed in the preschool program before the age of thirty (30) months without the written permission from the child's authorized representatives. LPA additionally advised that the toddler program shall be conducted in areas physically separated from those used by the preschool program and commingling shall not be permitted between components.
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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Brindha Govindasamy
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC809 (FAS) - (06/04)
Page: 5 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: STANFORD MADERA GROVE CHILDREN'S CENTER
FACILITY NUMBER: 435700793
VISIT DATE: 01/14/2026
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LPA advised that toddlers enrolled into the toddler component shall follow infant regulations, including nap check documentation and Infant Safe Sleep requirements, until they turn twenty-four (24) months of age.
LPA advised Applicants that the following first-aid supplies in a location accessible to staff but inaccessible to children: current edition of a first-aid manual, sterile first-aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometer, and antiseptic solution. Facility provides snacks to the children. The isolation area for children who are ill will be at the lobby or wellness room.

For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

Applicants were reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides 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 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Brindha Govindasamy
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
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: STANFORD MADERA GROVE CHILDREN'S CENTER
FACILITY NUMBER: 435700793
VISIT DATE: 01/14/2026
NARRATIVE
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LPA discussed the safe sleep regulations with Applicants 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 Applicants 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.

Applicants were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

A notice of site visit was given to Center Director and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process



The following is needed before a licensure is considered.

Final license determination for a single license will be made upon review by the Licensing Program Manager.

Exit interview was conducted, report was reviewed and copy of appeal rights were provided to Kimberly Kostepen, Center Director.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Brindha Govindasamy
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026
LIC809 (FAS) - (06/04)
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