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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421974
Report Date: 02/15/2023
Date Signed: 02/15/2023 11:35:38 AM


Document Has Been Signed on 02/15/2023 11:35 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:MONTESSORI SCHOOL OF PLEASANTONFACILITY NUMBER:
013421974
ADMINISTRATOR:GUTIERREZ, KATRINAFACILITY TYPE:
850
ADDRESS:3410 CORNERSTONE CTTELEPHONE:
(925) 484-3300
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:120CENSUS: 95DATE:
02/15/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Monica GalangTIME COMPLETED:
11:50 AM
NARRATIVE
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On February 15, 2023 the Licensing Program Analyst (LPA) Lorraine Dacanay Breaux met with the Director, Monica Galang for an unannounced Case Management - Lead Testing/Exceedance Visit . Present for today's inspection was 95 children in care and 17 additional staff. The facility operates Monday - Friday 08:30 AM - 06:00PM.

LPA and director toured the facility for heath and safety. A lead test sample was drawn at the facility on 12/08/2022. Lab results analyzed found that lead levels was greater than 5.5 ppb is deemed an Action Level Exceedance and requires the issuance of a deficiency and a Plan of Correction.

This facility is being given a Type B citation for California Code of Regulations, Title 22, Division 12 Chapter 1 Regulation number: 101238(a) Buildings and Grounds. Please see LIC 809D page for the citation. This water fountain is in the staff break room, was not used the the children. Per director, the water fountain was removed on January 4, 2023, therefore does not need to be retested. In addition, the children bring their own bottled water from home and when needed refilled. The facility does not prepare and/or cook food.

LPA viewed a plan of correction and the lead testing results posted in a public area.



In addition to the above, a Type B deficiency and plan of correction was documented and issued today, see LIC809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director, Monica Galang.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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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Document Has Been Signed on 02/15/2023 11:35 AM - 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 STE 1102
OAKLAND, CA 94612


FACILITY NAME: MONTESSORI SCHOOL OF PLEASANTON
FACILITY NUMBER: 013421974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2023
Section Cited

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101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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LPA observed the water fountain has been removed. Per director, water fountain in the staff break room was removed on January 4, 2023. This water fountain was not used for children to drink nor for cooking.
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The facility Sample ID 013421974-E –Drinking Fountain located between Oak and Maple had a Lead Action Level of Exceedance Response of more than 5.5ppb. This poses a potential health, safety and personal rights risk to children in care.
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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