Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407984
Report Date: 06/11/2015 12:00:00 AM
Date Signed 06/11/2015 10:53:03 AM

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:ABILITIES UNITED - MILESTONESFACILITY NUMBER:
434407984
ADMINISTRATOR:SHERADEN NICHOLAUFACILITY TYPE:
850
ADDRESS:3864 MIDDLEFIELD RDTELEPHONE:
(650) 618-3325
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:20CENSUS: 10DATE:
06/11/2015
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:SheradenTIME COMPLETED:
11:00 AM
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
An unannounced case management visit was made to the facility per licensee request. They are requesting an increase in their capacity by adding one room to their existing one. Currently they are licensed for 20 children and their request is to increase the capacity to 40 children.
Met with Sheraden and jointly toured facility.
Measurements are as follow:
Room 1 :
32 x 23.5= 752 sq ft minus encumbered space (15.416 x 1.5) + ( 6.5 x 2) = 715.876 sq ft
Room 2:
29.25 x 13.25 = 387.562
20 x 10.666 = 213.32
Total 600.882 sq ft, minus encumbered space (6.666 x 2) = 587.55 sq ft
Indoor therapy room:
19.583 x 14 = 274.162 minus encumbered space 4.916 x 1.333 = 267.609 sq ft
Total indoor space = 715.876 + 587.55 + 267.609 = 1571.035 divided by 35 = 44 student.

Out door space:
Outdoor space connected to room 2:
32.416 x 23.416 = 759.053 minus encumbered space 3.916 x 1.416 = 753.508 sq ft
Outdoor space connected to room 1:
49.916 x 67.416 = 3365.137 minus encumbered space 31.333 x 9.416 = 3070.1 sq ft
Total outdoor space = 753.508 + 3070.1 = 3823.608 divided by 75 = 50 students.
There are two toilets and three sinks in Room 1. There is one toilet, one sink and one changing table in the hallway. Staff will use the designated hallway bathrooms for adults. Discussed isolation of sick child and the sick child will be isolated in the office where there is a cot for the sick child. Diaper changing is done on the changing table available in room 1.
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Roya ShahkaramiTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2015
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ABILITIES UNITED - MILESTONES
FACILITY NUMBER: 434407984
VISIT DATE: 06/11/2015
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
Room 1 and room 2 have adequate lighting and heating. No medications will be dispensed. First aid supplies are stored inaccessible to the children and are appropriately equipped. Cleaning supplies are stored out of the reach of the children. They serve two snacks each day. They have accessible drinking water inside and outside. Garbage containers have tight fitting lids. Children nap at this program and they use cot for children. Facility provides sheets for the cots and parents provides blankets.
There is adequate equipment, supplies and toys for children.
Analyst observed that the entire campus and play area is fenced with gates.
Playground observed to have sand and cement area. There is a climbing structure with sand as resilient material. Shade is provided by trees and overhangs.
Sheraden stated that there is no firearm in the facility. There is a swimming pool in the building that they use for therapy. Pool observed to have a fence and several locked doors. The pool observed to be empty and not useable.
No transportation is provided. Fire Marshall has approved the facility for 40 children.
As of today, analyst to recommend license for 40 children ages 2- 5 years.


SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Roya ShahkaramiTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2