Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710194
Report Date: 12/11/2015
Date Signed 12/11/2015 03:42:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BARRON PARK KIDS' CLUBFACILITY NUMBER:
430710194
ADMINISTRATOR:MITCHELL, KANDICEFACILITY TYPE:
840
ADDRESS:800 BARRON AVE.TELEPHONE:
(650) 856-1220
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:80CENSUS: 30DATE:
12/11/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Kandice MitchellTIME COMPLETED:
03:50 PM
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A case management visit was made to the facility to check on supervision of children. Arrived at dismissal of children from elementary school. One teacher stood by the door way and signed children in. The have two after school rooms in one room, they had 12 children and in another room, they had 19 children.
During today's visit, ratio and supervision were correct. Children were under visual supervision at all time.
Prior to snack time, a teacher took a group of children to the bathroom.
No deficiency note and notice of site visit was posted.
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Roya ShahkaramiTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2015
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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