013420938-7-7-2022-52-CC-AWRT-CG4RL2-20220707130625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420938
Report Date: 07/07/2022
Date Signed: 07/07/2022 01:06:48 PM

Document Has Been Signed on 07/07/2022 01:06 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:	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: 40	DATE:	07/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Shimei Yang		TIME COMPLETED:	01:15 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 July 7th, 2022 @ 9:45am, Licensing Program Analyst (LPA) April Wright arrived for an unannounced Required-1 Year inspection, and met with Director Shimei Yang and July Grace Galaraga. There were 40 children and 6 fingerprint cleared staff members present during the inspection. The facility is in ratio today. The facility was toured for a health and safety inspection. Hours of operation are Monday through Friday 8:00am to 6:00pm. CLASSROOMS: Four (4) classrooms were inspected and have adequate play and learning materials available. Classroom four (4) is not in use since the pandemic and is inaccessible to children. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting for safety and comfort. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is in the director office, away from other children in care. The center has fully operational smoke and carbon monoxide detectors, working telephone, and four (4) fully charged 3A40BC fire extinguishers per each classroom. The center is equipped with fully stocked first aid kits that is available in all classrooms. BATHROOMS AND TOILETING AREAS: The staff's bathroom is separate from the children's bathroom. All sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets. Supplies are available to the children. FOOD SERVICE AREAS: This facility provides am snack, lunch and pm snack daily for children in care. There are monthly menus posted at the facility. All storage containers for solid waste have tight fitting covers that are in good repair. OUTDOOR PLAY AREAS: There's one (1) large play structure with a three (3) slides and small structure with tunnel that has cushioning to absorb falls that is anchored for stability. There is a canopy area with artificial grass that provides shade to children while at play. Facility also age appropriate toys that are in good condition. See LIC 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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 2

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: 07/07/2022

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

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Ten 10 children's files and six 6 staff files were reviewed. All staff files have required health screening and Employee Rights and all children files contain Identification & Emergency, Personal Rights, and Medical Consent forms. LPA reviewed the staff and children's roster and obtained a copy. Mandated Reporter Training certificates were reviewed and on file for all staff. The Facility Director CPR and First Aid certificate was in her file as well as other staff. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted monthly and the last one conducted was on 6/6/2022. All required documents are posted in a public accessible area.

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.

Incidental Medical Services (IMS) policy was discussed. IMS services are provided at this facility. 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

LPA discussed the Safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Shei Mei Yang and July Grace Galaraga.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2