013422412-5-5-2022-52-CC-RHAR-CE5Q8P-20220505115703

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422412
Report Date: 05/05/2022
Date Signed: 05/05/2022 11:57:14 AM

Document Has Been Signed on 05/05/2022 11:57 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:	LEARN AND PLAY MONTESSORI MAPLE, INC.		FACILITY NUMBER:	013422412
ADMINISTRATOR:	CHAPPELLE, AMY		FACILITY TYPE:	850
ADDRESS:	37220 MAPLE ST.		TELEPHONE:	(510) 713-2402
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY: 74	TOTAL ENROLLED CHILDREN: 65	CENSUS:	DATE:	05/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Amy Chappelle		TIME COMPLETED:	12:10 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 May 5, 2022 at approximately 8:05am, LPA Haderer arrived unannounced for an annual inspection for compliance to Health and Safety. The new CARE tool was used for the inspection. Present for the inspection was the site director Amy Chapelle; 8 teachers; 1 person from Child Care Careers and 53 children in care (all preschool age). The facility is in ratio today. The facility has 5 classrooms, a small kitchen/food prep area, 2 children’s bathrooms; staff bathroom, and outside playground area. There is a waiver for the playground area to require staff to rotate playground use to ensure no more than 61 children are there at one time. The playground area is surrounded by a 6-foot fence covered with a material to provide privacy. There are sturdy play structures, LPA observed that all play equipment is in safe condition and free from sharp, loose or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. There is water available for the children and they also bring their own bottled water to school. Shade is available in the playground area teachers are always present when the children are outside. Sign in/out sheets are done electronically. All children present were signed in. Classrooms have trash cans with tight fitting cover for the disposal of solid waste. The facility provides incidental medical services for EpiPen’s and antihistamine for children in care. Medications were checked safely stored, medications were not expired. Children’s bathrooms are available in the classrooms, there are enough towels and soap supplies. The staff have separate adult bathroom located on campus. Fire and Earthquake disaster drills are conducted monthly, the last drill was conducted 4-21-2022.

Chandra Charles
Russell Haderer
	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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: LEARN AND PLAY MONTESSORI MAPLE, INC.	FACILITY NUMBER: 013422412
	VISIT DATE: 05/05/2022

NARRATIVE

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The facility has fully charged 3A40BC fire extinguishers throughout the hallways and classrooms. The last annual inspection was done 9-2-2021. Trojan Systems Inc. conducts the fire systems inspections, the last inspection was completed on 2/14/2022 and all smoke detectors and the fire system are in good working order and passed inspection. Carbon monoxide detector was present, tested and functioning. Heating and ventilation in the classroom is acceptable.

The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. Hazardous items/toxins are kept out of the access of children. There are no bodies of water accessible to children in care. The facility provides snacks for the children, menus were appropriately posted throughout the facility. All dry good and canned foods were checked and not expired.

At 9:55am staff files were reviewed. All staff files are complete with the exception of one staff member that did not have the proof of MMR and Tdap available in the personnel file. See LIC809D for the deficiency. All other files were complete and in good order.

Children’s files were reviewed and found to be complete and in good order.

All documents required to be posted were appropriately posted on the walls: License (and playground waiver underneath); Emergency Disaster Plan; Earthquake Preparedness checklist; Notification of Parents Rights; Personal rights; Child seat belt laws; menus; daily activity schedules.

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

SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LEARN AND PLAY MONTESSORI MAPLE, INC.	FACILITY NUMBER: 013422412
	VISIT DATE: 05/05/2022

NARRATIVE

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Site Director 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/inspection-process.

There was 1 deficiency issued today, see LIC809D. This report will remain on file for 3 years.

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

Exit interview conducted and report was reviewed with the Site Director Amy Chapelle.

SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/05/2022 11:57 AM - It Cannot Be Edited

Created By: Russell Haderer On 05/05/2022 at 11:40 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LEARN AND PLAY MONTESSORI MAPLE, INC.	FACILITY NUMBER: 013422412
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that one staff member's personnel file did not contain proof of measles (MMR) nor Pertussis (Tdap) vaccinations which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/16/2022
	Plan of Correction
1 2 3 4	Center Director will ensure the staff member collects and provides proof of vaccination.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Charles

LICENSING EVALUATOR NAME:

Russell Haderer

LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022

LIC809 (FAS) - (06/04)

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