013421338-2-23-2022-52-CC-LDBX-CBWT2S-20220223132115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421338
Report Date: 02/23/2022
Date Signed: 02/23/2022 01:21:25 PM

Document Has Been Signed on 02/23/2022 01:21 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:	PLEASANTON BILINGUAL MONTESSORI SCHOOL		FACILITY NUMBER:	013421338
ADMINISTRATOR:	LI GUAN		FACILITY TYPE:	830
ADDRESS:	5724 W. LAS POSITAS BLVD		TELEPHONE:	(925) 460-9920
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	21	CENSUS: 9	DATE:	02/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Li Guan		TIME COMPLETED:	01:45 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 February 23, 2022 at 10:45 AM., Licensing Program Analyst (LPA) Lorraine Dacanay Breaux and (LPA) Elimika Woods conducted an unannounced 1 Year Required Inspection and met with Facility Representative, Li Guan. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Facility Representative. There were fifteen 9 (nine) children present during this inspection and four additional staff members. This facility consist of preschool component #13421337. This center operates 8:00 AM – 6:00 PM. The facility was toured inside and out for a health and safety inspection. CLASSROOMS: The one classroom was inspected. There are adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. 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's office away from the children in care. The center has a wired smoke detector, a carbon monoxide detector, working telephone, pull down fire alarm system, and a four fully charged 3A40BC fire extinguisher. 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 provide snacks for the children. There are weekly menus posted at the facility. LPA observed an area where they have a refrigerator this area is clean and free of evidence of rodents and litter. See 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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: PLEASANTON BILINGUAL MONTESSORI SCHOOL	FACILITY NUMBER: 013421338
	VISIT DATE: 02/23/2022

NARRATIVE

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OUTDOOR PLAY AREAS: There's a play structure that has cushioning to absorb falls. There are trees that provides shade to children while at play.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Children's files and Staff files were reviewed around 12:30 PM. All staff files have required Health Screening, and Employee Rights and all children files contains Personal Rights, Identification and Emergency, and Medical Consent forms. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed, and certificates were reviewed. The Facility Representative CPR and First Aid certificate is current and expires on 01/23/2023. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 02/03/2022. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: There's no IMS being provided at this time and no medication being stored at the facility. The center is equipped with a fully stocked first aid kit that is available in the classroom.

California Law requires Child Care Centers 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. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

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.

See 809-C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PLEASANTON BILINGUAL MONTESSORI SCHOOL	FACILITY NUMBER: 013421338
	VISIT DATE: 02/23/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. 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

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.

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.

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, Li Guan

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC809 (FAS) - (06/04)

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