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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412388
Report Date: 08/03/2023
Date Signed: 08/03/2023 01:06:43 PM


Document Has Been Signed on 08/03/2023 01:06 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 EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:MONTESSORI SCHOOL OF CENTERVILLEFACILITY NUMBER:
013412388
ADMINISTRATOR:MATICHAK, LYSAFACILITY TYPE:
850
ADDRESS:4209 BAINE AVENUETELEPHONE:
(510) 797-9944
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:85CENSUS: 25DATE:
08/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lysa MatichakTIME COMPLETED:
01:15 PM
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On August 3, 2023 at approximately 8:30am Licensing Program Analyst (LPA) Russ Haderer arrived unannounced to conduct an inspection for health and safety. LPA met with Site Director Lysa Matichak, present for the inspection was the site director, four staff members and 15 children in care (age early 4 to 5) and 10 toddlers (age 18 to 36 months). All adults present are background cleared and associated to the facility. The hours of operation are 7:00am to 6:00pm.

There are two separate buildings on the site. The main building has three administration offices; staff toilet; kitchen, two separate classrooms with two children’s bathrooms containing three toilets and four sinks. The second building for toddlers has two classrooms; an office with a staff bathroom; small kitchenette, and two children’s bathroom with a total of four toilets and four sinks. The bathrooms have appropriate hand washing signage and there are enough hand towels and soap. All toilets, handwashing and cleaning areas are in safe and sanitary operating condition.

The outside contains two separate play areas and an additional area with picnic tables. There are storage sheds for toys and equipment and supplies. All play equipment is in safe condition and free from sharp, loose, or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. Shade was available in the play areas and teachers will always be present.
The facility is clean and well organized with ample age-appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. There were no hazardous items/toxins observed to be accessible to children in care today. There are no bodies of water accessible to children in care.
The facility has fully charged fire extinguishers in each building. The last inspection and service was completed on April 6, 2023. Fremont Fire Department completed their annual fire inspection on May 16, 2023. There are working carbon monoxide detectors (tested and working) and smoke alarms in the buildings. Heating and ventilation are acceptable. Disaster drills (earthquake and fire) are conducted monthly. The last drill was conducted on July 12, 2023.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI SCHOOL OF CENTERVILLE
FACILITY NUMBER: 013412388
VISIT DATE: 08/03/2023
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The school provides breakfast, hot lunches (from Fremont Unified School District) and afternoon snacks, all menus are posted. Children bring in their own food for any special requirements or preferences. There is an outside drinking fountain that is not in use at this time, however, children bring their own water bottles and water is also available if they forgot theirs or have run out. Snack food and canned goods stored in the kitchen were checked for expiration dates (frozen and refrigerated foods were also checked) and found to be acceptable.
Napping cots are available for children that need to sleep and items for sleeping are labeled with their names in cubbies. All classrooms have cubbies for children’s personal belongings (including the bedding for napping cots), personal items do not come into contact with other personal items. Sleep logs are maintained for children under the age of two, LPA verified the log.

The school uses manual sign in/out sheets with clean pen bins and used pen bins. The sign-in/sign-out notebooks are on a table near the entrance gate. Sign-in/out sheets were checked, there were three children present that had not been signed in by their parent - see LIC809D for deficiency. Covid protocol is followed (temperatures measured, hand washing (or sanitizer used) upon entry.

Children's files were reviewed, a photo copy of the roster was taken for the office file. All children’s files were complete and well organized. Staff files were reviewed. All staff subjected to criminal review have been cleared and associated to the facility. All files were complete, up to date and found to be in compliance with Title 22 regulations.

Site 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. LPA discussed the safe sleep regulations with Site Director 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 Site Director 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.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI SCHOOL OF CENTERVILLE
FACILITY NUMBER: 013412388
VISIT DATE: 08/03/2023
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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/childqanda.htm

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. 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). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. 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.

Site Director was informed of the MyChildCarePlan.org website; 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.

There was 1 deficiency found today:

- Sign-in sheets had not been filled out for three children present in the facility

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Director Lysa Matichak.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/03/2023 01:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: MONTESSORI SCHOOL OF CENTERVILLE
FACILITY NUMBER: 013412388

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that three children present in the center had not been signed in by their parent which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2023
Plan of Correction
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Site director will station staff at the sign in table to ensure that all parents sign in their children on entry to the school. Email will be sent to all parents (and a special note the parents of the three children) reminding them to sign in daily. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4