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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421418
Report Date: 07/14/2022
Date Signed: 07/14/2022 04:10:17 PM


Document Has Been Signed on 07/14/2022 04:10 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:RISING SUN MONTESSORI SCHOOLFACILITY NUMBER:
013421418
ADMINISTRATOR:PINEDA, GLORIAFACILITY TYPE:
850
ADDRESS:1089 SAN PABLO AVETELEPHONE:
(510) 528-6041
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY:35CENSUS: 18DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Gloria C. PinedaTIME COMPLETED:
04:24 PM
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On Thursday, July 14, 2022 at 10:21 AM, Licensing Program Analyst (LPA) Caroline Colson, arrived at the facility and met with Gloria C. Pineda, Center Director to conduct an annual required inspection. A Health and Safety Inspection was conducted. LPA made the following observations:

Capacity/Staffing: There are 18 preschool children with 6 staff members including the director and the music teacher.

Physical Plant: The Main Building consists of a large classroom with a kitchen area and two bathrooms. The second section of the center is a converted home with two classrooms, an office, a bathroom, kitchen and a hallway which leads to the fenced back yard. All bathrooms were inspected. There is adequate heating, lighting and ventilation. There are no cleaning solutions, chemicals or other hazards accessible to children.

Classrooms: Furniture and equipment age appropriate and in good repair. There are separate storage areas for children’s belongings. Children nap at the facility. There are mats and bedding materials for the children. Bedding materials are washed every week by the parents. The facility provides all snacks. Families provided lunches for their children. The menu is posted for review.

Restrooms: Toilets and sinks are operable. There is soap, toilet paper and paper towels for sanitary use.

Play yard: Climbing structures, slides are safe and in good condition. Playground is free of debris and other hazards. Drinking water is readily available. There are no pools, hot tubs or other bodies of water present.

Please LIC 809 C for additional information
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
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 4


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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: RISING SUN MONTESSORI SCHOOL
FACILITY NUMBER: 013421418
VISIT DATE: 07/14/2022
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Emergency Preparedness/Safety: Smoke detector was inspected by an outside company. Carbon monoxide detectors were tested and are working. The 2A10BC fire extinguishers were serviced in January 2022. Pediatric CPR and First Aid Certificates are current and expire on April 30, 2023. Mandated Reporter Training Certificate is current and expired on June 28, 2023. First Kit is available and complete. Emergency Disaster Plan is posted. The facility utilizes a land line telephone.

Postings: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist.

Sign in Sheet/Class Roster: All parents sign in and use a full legal signature. The roster is current and available.

Training/Record Review:
Immunization records including influenza and or a statement declining the vaccination.

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

Gloria Pineda 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.

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: RISING SUN MONTESSORI SCHOOL
FACILITY NUMBER: 013421418
VISIT DATE: 07/14/2022
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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.

The attached type B deficiency is being cited today and must be corrected by the due date.



A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Facility Representative, Gloria C. Pineda.

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/14/2022 04:10 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: RISING SUN MONTESSORI SCHOOL

FACILITY NUMBER: 013421418

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 07/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(b)
Child's Medical Assessments
(b) The medical assessment shall provide the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one child not having a physician report on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2022
Plan of Correction
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Licensee will send a copy of the physician report.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4