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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423095
Report Date: 09/21/2021
Date Signed: 09/21/2021 05:38:53 PM

Document Has Been Signed on 09/21/2021 05:38 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:PRIDE IN LEARNING MONTESSORI SCHOOLFACILITY NUMBER:
013423095
ADMINISTRATOR:LEON, DARA E.FACILITY TYPE:
830
ADDRESS:1707 GOULDIN ROADTELEPHONE:
(510) 219-5189
CITY:OAKLANDSTATE: CAZIP CODE:
94611
CAPACITY: 13TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
09/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Dara LeonTIME COMPLETED:
05:53 PM
NARRATIVE
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Licensing Program Analyst (LPA) Caroline Colson, arrived at the facility at 10:48 AM and met with Dara Leon, Center Director, to conduct an annual required inspection. Dara provided the guided tour. Ten children's records and three staff's records were reviewed by the LPA and the licensee on 9/21/21 at 11:48 AM. All children have complete files. LPA made the following observations:

Capacity/Staffing: The facility is an infant program. There are two classrooms in the infant program with toddler option. There are 10 infants including toddlers with 3 teachers and the Center Director.

Physical Plant: The facility is a two (2) story building with two (2) classrooms. There are restrooms. 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. Infants do take naps at facility. There is one crib for one infant. There are mats and bedding materials for the toddlers. Bedding materials are washed every week by the parents. 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: A climbing structure, a slide and other play equipment are safe and in good condition. There is a shaded area. Playground is free of debris and other hazards. Children have their own water bottle to refill. There are no pools, hot tubs or other bodies of water present.
Please See LIC 809 C for additional information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PRIDE IN LEARNING MONTESSORI SCHOOL
FACILITY NUMBER: 013423095
VISIT DATE: 09/21/2021
NARRATIVE
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Emergency Preparedness/Safety: Carbon Monoxide detector was tested. Smoke Detectors are hard wired and were tested in April 2021. The 3A40BC fire extinguishers was serviced in April 2021 as well. First Aid Kit is available and complete. Emergency Disaster Plan is posted. The facility utilizes a cell phone.

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

Sign in Sheet/Class Roster: All parents use an electronic signature to sign in and sign out. The roster is available.

Training/Record Review:
All staff present on this date have criminal background clearances and are associated to the facility. Staff have current CPR/First Aid and Mandated Reporter certificates on file.

Licensee 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.

The 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 ADA, available at: http://www.ada.gov/childquanda.htm.



Please Additional LIC 809 C for further information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 09/21/2021 05:38 PM - It Cannot Be Edited


Created By: Caroline Colson On 09/21/2021 at 04:24 PM
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIDE IN LEARNING MONTESSORI SCHOOL
FACILITY NUMBER: 013423095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101439(h)
Infant Care Center Fixtures, Furniture, Equipment and Supplies
(h) Infant changing tables shall:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above because there is not a changing table for the toddler room which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2021
Plan of Correction
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Licensee will purchase a changing table and send a picture to CCL by POC Due Date.
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
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Based on observation, interview, record review, the licensee did not comply with the section cited above because three out of four staff members are missing immunization records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2021
Plan of Correction
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Licensee will have all the staff members obtain the required immunizations and send to CCL by POC Due Date.
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 Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2021


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 09/21/2021 05:38 PM - It Cannot Be Edited


Created By: Caroline Colson On 09/21/2021 at 04:24 PM
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIDE IN LEARNING MONTESSORI SCHOOL
FACILITY NUMBER: 013423095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above because four out of four staff members didn't complete the Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2021
Plan of Correction
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Licensee will have all staff complete the Mandated Reporter Training and send copies of certificates to CCL by POC Due Date.
Type B
Section Cited
CCR
101216(l)(1)(B)
Personnel Requirements
(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above because three staff member didn't have the employee rights on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2021
Plan of Correction
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Licensee will provide the form to all three employees to complete and send copies to CCL by POC Due Date.
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 Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2021


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 09/21/2021 05:38 PM - It Cannot Be Edited


Created By: Caroline Colson On 09/21/2021 at 04:24 PM
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIDE IN LEARNING MONTESSORI SCHOOL
FACILITY NUMBER: 013423095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above because one child does not have consent for medical treatment in file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2021
Plan of Correction
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Licensee will provide the family with a copy of the Consent for Medical Treatment to complete and send copies to CCL by the POC Due Date.
Type B
Section Cited
CCR
101220.1(a)
Immunizations
(a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above because two children didn't have immunization records in file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2021
Plan of Correction
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Licensee will request immunization records from both families and send copies of these records to CCL by the POC Due Date.
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 Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2021


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 09/21/2021 05:38 PM - It Cannot Be Edited


Created By: Caroline Colson On 09/21/2021 at 04:24 PM
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIDE IN LEARNING MONTESSORI SCHOOL
FACILITY NUMBER: 013423095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Immunizations
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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4
Type B
Section Cited
CCR
101226(e)(5)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (5) The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above for one child who has medication stored at the facility without a written plan in place poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2021
Plan of Correction
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Licensee needs to develop a written specifically for each child that is receiving medication and send a copy to CCL by POC Due Date.
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 Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2021


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 09/21/2021 05:38 PM - It Cannot Be Edited


Created By: Caroline Colson On 09/21/2021 at 04:24 PM
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIDE IN LEARNING MONTESSORI SCHOOL
FACILITY NUMBER: 013423095

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.3(a)
Modifications to Infant Needs and Services Plan
(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above because two children didn't have current quarterly Infant Needs and Service Plans available for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2021
Plan of Correction
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Licensee will meet with each family to develop a current Infant Needs and Service Plan for both families and send copies to CCL by POC Due Date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mayla Mendoza
LICENSING EVALUATOR NAME:Caroline Colson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2021


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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: PRIDE IN LEARNING MONTESSORI SCHOOL
FACILITY NUMBER: 013423095
VISIT DATE: 09/21/2021
NARRATIVE
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The attached type B deficiencies are 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. Exit interview conducted and report was reviewed with the licensee, Dara Leon.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC809 (FAS) - (06/04)
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