013412619-3-18-2022-52-CC-KPHN-CCMTQJ-20220318145600

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013412619
Report Date: 03/18/2022
Date Signed: 03/18/2022 02:56:07 PM

Document Has Been Signed on 03/18/2022 02:56 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	MONTESSORI CHILDREN'S CENTER		FACILITY NUMBER:	013412619
ADMINISTRATOR:	KHAN, YASMIN		FACILITY TYPE:	830
ADDRESS:	33170 LAKE MEAD DRIVE		TELEPHONE:	(510) 489-7510
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY:	20	CENSUS: 6	DATE:	03/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Yasmin Khan		TIME COMPLETED:	03:15 PM

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	On 03/18/2022 at 8:50am Licensing Program Analyst (LPA) Kelly Phan conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION. LPA Phan met with Yasmin Khan (Director) and Injerdit Kaur (Assistant Director), also present at the time of this inspection were 2 staff and 6 infants. The facility is within ratio and capacity compliance today. The facility was toured to conduct a Health and Safety Inspection. This program current operates Monday-Friday 7:00am-6:00pm out of two classrooms (Willow and Lenido). Both classrooms were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces, the presence of working carbon monoxide detector, smoke detectors/fire alarms and a fully charged fire extinguishers size 3A-40-BC that is accessible throughout the facility. The changing tables are within arm’s reach of the sink. The outdoor play area is fully fenced and has shade along with grass near play structures. There is padding under/around the climbing equipment. LPA observed the play structures to be fully intact with no visual defects or concerns. There are no pools, hot tubs or other accessible bodies of water. Per director, there are no firearms and smoking present on the premises. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. The facility serves lunch, morning, and afternoon snack, menu is also posted however the director states she has not updated. LPA reviewed storage of food and reminded director that all food must be in original packaging or labeled with expiration date. The refrigerator in the classroom was observed, and had one bottle that did not have a name or date on it. The center also conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on 02/07/2022. LPA informed staff and director that cribs should not have any blankets, toys, or any objects attached or inside the crib to prevent a choking hazard. Staff immediately removed objects and blankets while LPA was present. LPA also confirmed that the facility does not have a sleep log in place. LPA informed director to send proof of sleep log and LIC 9227 by 3/23/2022. SEE LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI CHILDREN'S CENTER	FACILITY NUMBER: 013412619
	VISIT DATE: 03/18/2022

NARRATIVE

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A copy of the facility personnel roster and children’s roster were available for review and copy was obtained. LPA reviewed the file of 6 infant and 6 staff members files, who are fingerprint cleared and associated to the facility. LPA reminded director to renew mandated reporter training every 2 years and to send proof by 04/08/2022. Some staff files were also missing proof of flu shot or declaration of declining flu shot to send proof by 3/25/2022. All staff have current CPR/First Aid certificates, and proof of education and/or experience was also present. LPA also reviewed the sign in/out sheet that shows 6 signatures for 6 infants present at the facility. Staff interview also conducted and documented.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirement shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the facility director, Yasmin Khan

This facility does not provides Incidental Medical Services – IMS. 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
see LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI CHILDREN'S CENTER	FACILITY NUMBER: 013412619
	VISIT DATE: 03/18/2022

NARRATIVE

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Facility Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with facility representative 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 facility representative 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: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC809 (FAS) - (06/04)

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