013421383-9-8-2022-52-CC-JSAI-CJ3PNY-20220908112844

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421383
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:28:51 AM

Document Has Been Signed on 09/08/2022 11:28 AM - 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:	BEYOND MONTESSORI SCHOOL		FACILITY NUMBER:	013421383
ADMINISTRATOR:	SHU JEN JAI		FACILITY TYPE:	850
ADDRESS:	7260 SAN RAMON ROAD		TELEPHONE:	(925) 556-2588
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	60	CENSUS: 27	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Sophia Jai		TIME COMPLETED:	11:50 AM

NARRATIVE

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Licensing Program Analyst (LPA) Jyoti Saini met with Admin incharge Anthoney Jai for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Staff. Director arrived during the inspection. In addition to the director, there are 27 children and 4 staff present today. The facility operates Monday - Friday from 8:00 AM to 6:00 PM in the explorers, scholars and cultivator’s classrooms. The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed;

There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit and a first aid backpack are available. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition. There are separate bathrooms for the children and staff. Children bathrooms have 4 toilets and 4 sinks. The bathrooms appear to be safe, sanitary, and free of any hazardous items. There is drinking water readily available for children. The program provides daily snacks and children bring their own lunch. The classroom has appropriate postings. The last Emergency Drill was conducted on 05/31/2022 and is properly logged.

LPA reviewed sign-in and out sheet. The center does not have a complete record of sign in and out sheet. There are multiple first aid kits available. There is a working fire alarm system in the facility. The facility has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available.

Eight children records reviewed were complete. All children have a record of emergency identification information on file. Five staff records reviewed were complete. All staff has a criminal record clearance on file. The site Director has a current Pediatric First Aid/CPR certificate on file. All staff has taken Mandated Reporter training except the director. A copy of the facility personnel roster and children’s roster were available for review and copy was obtained.

see next page...

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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: BEYOND MONTESSORI SCHOOL	FACILITY NUMBER: 013421383
	VISIT DATE: 09/08/2022

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During inspection,

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.

Site Director was reminded about Mandated Reporter Training available on the CCLD website. Training must be completed every two years. (Websites: www.ccld.ca.gov or www.mandatedreporterca.com)

Site Director was reminded about the Provider Information Notices (PINs) on the CCLD website.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

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 however technical violations were being provided regarding sign in/out and mandated reporter training.

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, Sophia Jai.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

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