<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418197
Report Date: 11/21/2022
Date Signed: 11/21/2022 02:52:16 PM


Document Has Been Signed on 11/21/2022 02:52 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:LITTLE FLOWERS MONTESSORI, INCFACILITY NUMBER:
013418197
ADMINISTRATOR:MAGGIE BALTAZARFACILITY TYPE:
850
ADDRESS:34735 ARDENWOOD BLVD.TELEPHONE:
(510) 793-1696
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:217CENSUS: 174DATE:
11/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Hue HuynhTIME 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 November 21, 2022 approximately at 12:40PM Licensing Program Analyst (LPA) Kelly Phan met with Hue Huynh (Assistant Director) for the purpose conducting a case management inspection regarding high levels of lead analysis sent to the Department on November 17, 2022. The center director was not present today as she is assisting at another facility in Pleasanton. Present for this inspection was 165 preschool aged children and 9 toddlers (total of 174) along with 11 fingerprinted and associated staff members. LPA entered the facility and began the inspection to conduct a health and safety check.

At 1:00PM, LPA toured all ten classrooms with assistant director and inspected the two classrooms (Magnolia and Lotus) where high levels of lead was found. LPA observed that the two faucets had plastic coverings to prevent any children and staff from accessing the water sources. The facility is also using water coolers/pitchers with filtered water, which comes directly from the facility kitchen filtering system that was previously inspected during lead testing. Per Ms. Hue, the filtered water system in the kitchen was deemed safe for drinking water; Water fountains outside and inside of the facility were also inspected and was deemed safe for children to drink. The facility also is in the process of ordering a new faucet part to replace the faucets located in the two classrooms; per Ms. Hue the maintenance order is not present to review as the owner had taken it with him, but states that the new parts may take approximately 2 to 3 weeks to arrive. A Type B will be cited today as there were high levels of lead found present at the two classrooms, see LIC 809D. During the physical tour and file review, LPA also verified with Hue and Guardian that one of her staff members was separated on 08/14/22 due to a leg surgery and decided to come back to work early; LPA informs Ms. Hue that she does not have a eligible background today, a civil penalty of $100.00 will be assessed along with a Type A, SEE LIC 809D.


SEE LIC 809 C








SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
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 4


Document Has Been Signed on 11/21/2022 02:52 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: LITTLE FLOWERS MONTESSORI, INC
FACILITY NUMBER: 013418197

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2022
Section Cited

1
2
3
4
5
6
7
Criminal Record Clearance 101170(e): All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on interview and record review on Guardian, the facility did not comply with the section cited above as 1 staff member does not have eligible background clearance at the facility, which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LITTLE FLOWERS MONTESSORI, INC
FACILITY NUMBER: 013418197
VISIT DATE: 11/21/2022
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
There were two deficiencies were cited for today's inspection
1 Type A - One staff member did not have a fingerprint clearance
1 Type B - High levels of lead was found at the facility

LPA Kelly PHAN informed assistant director, Hue Huynh that this report dated 11/21/2022 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Kelly PHAN informed the assistant director to provide a copy of this licensing report dated 11/21/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with assistant director, Hue Huynh


SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/21/2022 02:52 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: LITTLE FLOWERS MONTESSORI, INC
FACILITY NUMBER: 013418197

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2022
Section Cited

1
2
3
4
5
6
7
Building and Grounds 101238 (a)The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on observation, interview, and record review, the facility did not comply with the section cited above as there were high levels of lead found in two classrooms, which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Facility will also have to retest both water faucets to ensure both water sources are safe for food preparation and drinking

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly PhanTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4