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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419470
Report Date: 10/28/2020
Date Signed: 12/30/2020 10:31:32 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:AMERICAN INTERNATIONAL MONTESSORI SCHOOLFACILITY NUMBER:
013419470
ADMINISTRATOR:TAKAGI, SAKIKO/MAHR, ERNIEFACILITY TYPE:
850
ADDRESS:3339 MARTIN LUTHER KING JR WAYTELEPHONE:
(510) 868-1815
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:117CENSUS: 0DATE:
10/28/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ernest MahrTIME COMPLETED:
10:15 AM
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On 10/28/20 at 10am, Licensing Program Analyst (LPA) Loretta Dyson conducted a case management tele-inspection thru the FaceTime application. A tele-inspection was done due to the COVID-19 pandemic. LPA met with Ernest Mahr, the director. A request for a temporary unique waiver to use an outdoor activity space that is not part of the license was received and is under review. There is also a private elementary school on site. The inspection was conducted with Mr. Mahr focusing the camera around the outdoor space so LPA could view it. LPA observed that the outdoor space is fully fenced and consists of an area with turf and a blacktop area. LPA observed a climbing wall, which he indicated will be off limits to preschoolers. LPA observed a small pod on the yard that has been emptied and covered. LPA observed that a barrier has been place between the spaces of the ramp to prevent children from falling through. LPA did not observe any defects of dangerous conditions.

LPA reminded Mr. Mahr that the waiver needs to be approved prior to using the additional outdoor space. An electronic signature will not be obtained from the licensee, but the report will be mailed to the licensee for signature.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: (510) 622-2633
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020
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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