013420938-8-11-2021-52-CC-JWIN-C5SQB3-20210811120051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420938
Report Date: 08/11/2021
Date Signed: 08/11/2021 12:01:44 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:	EMPIRE MONTESSORI PRESCHOOL		FACILITY NUMBER:	013420938
ADMINISTRATOR:	BALAJONDA, EVA MARIA		FACILITY TYPE:	850
ADDRESS:	3765 WASHINGTON BLVD		TELEPHONE:	(510) 979-1696
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY:	120	CENSUS: 35	DATE:	08/11/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Weijia Cai & Mei Yang		TIME COMPLETED:	11:45 AM

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On 08/11/2021 Licensing Program Analyst (LPA) Jabari Wilson conducted a 1 year required UNANNOUNCED ANNUAL INSPECTION. LPA met with Administrator Weijia Cai and the facility was toured to conduct a Health and Safety Inspection. Also present at the time of this inspection was Director Isabel Baltazar (filling in for a teacher in Room 1), Owner Mai Yang, 3 staff members, and 35 children. The facility is within ratio and capacity compliance today. This program operates out of 4 classrooms. All classrooms were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. Room 4 is currently closed due to low enrollment numbers and will serve as an isolation room if need be. LPA observed the cleanliness of floors and surfaces, the presence of working dual carbon monoxide/smoke detectors, fire alarms, and 4 fully charged 3A40BC fire extinguishers in every room that is accessible. The bathrooms have age appropriate faucets and toilets in working condition. The outdoor play area is large and fully fenced. There is rubber padding under/around the climbing equipment. The play structures appear to be fully intact with no visual defects or concerns. There are no pools, hot tubs or other accessible bodies of water. Cleaning supplies/toxins are stored inaccessible to children. All required postings are present. The facility serves snacks and lunch and posts the updated menu weekly while also giving the parents the option to provide children with their own food. LPA reviewed storage of food, medication and medical equipment/supplies and is inaccessible to the children. Per Administrator, there are no firearms present on the premises.

A copy of the facility personnel roster and children’s roster was obtained. LPA reviewed the file of 8 children enrolled in the program and 6 staff members files, who are fingerprint cleared, completion of Mandated Reporter training (some outdated) as well as proof of immunizations. Each child's file reviewed is complete and contains a medical assessment.

SEE LIC809 C FOR CONTINUANCE

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Jabari Wilson	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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: EMPIRE MONTESSORI PRESCHOOL	FACILITY NUMBER: 013420938
	VISIT DATE: 08/11/2021

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The opener and closer is Director Isabel Baltazar; records indicate that she has a current CPR/First Aid certificate that expires 08/08/2022 respectfully, and proof of education and/or experience was also present. The center also conducts and documents fire and earthquake drills every month and the log shows that the last drill was conducted on 07/09/2021.

LPA also discussed with the Administrator that ALL assistants, volunteers, frequent visitors, over the age of 18, must be fingerprint cleared and associated prior to being in the presence of children in care. An immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Administrator was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years. LPA also encouraged the Administrator to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded.

Individual Medical Services (IMS) policy was discussed. The Administrator is reminded that when any changes to the IMS plan is made, an updated Plan for Providing 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 website at: http://www.ada.gov/childqanda.htm.

For licensing updates, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

There are no deficiencies cited today, however technical assistance was provided (SEE LIC 9102). This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with Administrator Weijia Cai and Owner Mai Yang.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Jabari Wilson	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC809 (FAS) - (06/04)

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