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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412619
Report Date: 07/25/2019
Date Signed: 07/25/2019 04:24:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTESSORI CHILDREN'S CENTERFACILITY NUMBER:
013412619
ADMINISTRATOR:KHAN, YASMINFACILITY TYPE:
830
ADDRESS:33170 LAKE MEAD DRIVETELEPHONE:
(510) 489-7510
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:20CENSUS: 16DATE:
07/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Yasmin KhanTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Julia Placencia arrived at the facility at 1:50pm for an unannounced Annual/Random inspection, and met with director Yasmin Khan. There were 16 infants and 5 staff members present during the inspection. The facility was toured for a health and safety inspection. The hours of operation are Monday through Friday 7:00am to 6:00pm.

Furniture and napping equipment observed during inspection were age appropriate and in good condition. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the inspection. The floors were free of tripping hazards. LPA observed the food preparation and storage areas to be clean, and free of evidence of rodents, and food is protected against contamination. All storage containers for solid waste have tight-fitting covers that are in good repair. Drinking water is available both indoors and outdoors. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment was observed to be safe, free of hazards and had appropriate cushioning material to absorb falls. There is a shaded area provided for the children. Required licensing documents were posted. Fire extinguishers, carbon monoxide and smoke detectors meet State Fire Marshall standards.

The facility is operating within its licensed capacity. The facility is within ratio today with 1 teacher supervising no more than 4 Infants. LPA did not observe any child left without visual supervision during the inspection. LPA verified both opening and closing staff have current CPR/First aid training. A physical census was taken of all children present and crossed referenced with the sign in and out sheets.

At 3:00pm, a sample of children’s files were reviewed. All files reviewed contain required licensing documents. Staff files were reviewed and contain required licensing documents, proof of immunizations and current mandated reporter training. Teachers present today meet the qualification requirements.

***Continued on LIC809C....
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412619
VISIT DATE: 07/25/2019
NARRATIVE
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The following deficiencies were observed during today's inspection:
  • At 2:15pm, LPA observed all bottles of milk/formula in refrigerators were not properly labeled with names and current dates.
  • At 2:30pm LPA observed 6 of 16 children present today were not properly signed in. 5 children were not signed in on correct date, and 1 child was not signed in at all.

The Director is reminded that ALL Staff must be fingerprint cleared prior to being in the presence of children in care, or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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)/ (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

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

See LIC809D for deficiencies cited during today's inspection. 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.

Exit interview conducted with Yasmin Khan. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412619
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2019
Section Cited
CCR
101427(j)
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Infant Care Food Service -
Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.
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Director shall develop a plan on how she will ensure all bottles/containers are properly labeled with child's name and current date. Submit plan to CCL by due date of 8/1/19.
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This requirement is not met as evidenced by:
Based on observation, infant bottles were not properly labeled, which poses a potential health and safety risk to children in care. All bottles in refrigerators did not have dates, and 2 bottles did not have names.
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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.
Type B
08/01/2019
Section Cited
CCR
101229.1(b)
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Sign in and Sign Out -
The person who brings the child to, and removes the child from, the center shall sign the child in/out.
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Director shall develop a plan ensuring all children are signed in/out properly. Submit plan to CCL by due date of 8/1/19.
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This requirement is not met as evidenced by:
Based on observation, 6 of 16 children were not signed in properly, which poses a potential health and safety risk to children in care. 5 children were signed in on the wrong date, and 1 child was not signed in at all.
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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.
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: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3