073402302-10-27-2022-02-CC-THAR-CKLUKD-20221027153859

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402302
Report Date: 10/27/2022
Date Signed: 10/27/2022 03:39:18 PM

Document Has Been Signed on 10/27/2022 03:39 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:	ANGELS MONTESSORI PRESCHOOL - CONCORD		FACILITY NUMBER:	073402302
ADMINISTRATOR:	KARAMPOUR, ANGEL		FACILITY TYPE:	850
ADDRESS:	1566 BAILEY ROAD		TELEPHONE:	(925) 686-5621
CITY:	CONCORD	STATE: CA	ZIP CODE:	94520
CAPACITY:	49	CENSUS: 8	DATE:	10/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	MARYAM KARAMPOUR		TIME COMPLETED:	04:00 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	LICENSING PROGRAM ANALYST TASHA ALEXANDER MET TODAY WITH CENTER DIRECTOR MARYAM KARAMPOUR FOR AN UNANNOUNCED 1 YEAR/REQUIRED INSPECTION. TODAY THERE ARE 8 PRESCHOOL AGE CHILDREN PRESENT ALONG WITH CENTER DIRECTOR AND 1 TEACHER. THE FACILITY HAS AGE APPROPRIATE FURNITURE AND NAPPING EQUIPMENT WHICH APPEARS TO BE IN GOOD REPAIR. THE INDOOR AND OUTDOOR ACTIVITY SPACE APPEARED TO BE IN GOOD REPAIR. DISINFECTANTS, CLEANING SOLUTIONS, POISONS AND OTHER ITEMS THAT ARE DANGEROUS TO CHILDREN WERE INACCESSIBLE DURING TODAY'S INSPECTION. THE SINKS WERE OBSERVED TO BE IN OPERABLE CONDITION. THE FLOORS ARE FREE OF TRIPPING HAZARDS. LUNCHES ARE BROUGHT FROM HOME. FACILITY PROVIDES SNACKS. THE STORAGE AREA WAS OBSERVED TO BE CLEAN AND FREE OF EVIDENCE OF RODENTS. SNACKS ARE PROTECTED AGAINST CONTAMINATION. ALL STORAGE CONTAINERS FOR SOLID WASTE HAVE TIGHT FITTING LIDS THAT ARE IN GOOD REPAIR. DRINKING WATER IS AVAILABLE BOTH INDOORS AND OUTDOORS. MENUS ARE POSTED NEAR THE SIGN IN SHEETS AND VISIBLE FOR PARENTS TO REVIEW. OUTDOOR ACTIVITY SPACE AND PLAYGROUND EQUIPMENT WAS OBSERVED TO BE SAFE AND FREE OF HAZARDS WITH APPROPRIATE MATERIAL/BARK TO ABSORB FALLS. THERE ARE TREES ON THE PLAYGROUND TO PROVIDE SHADED AREAS FOR CHILDREN. THE FACILITY IS OPERATING WITHIN IT'S LICENSED CAPACITY. THE FACILITY IS WITHIN RATIO TODAY. LPA OBSERVED 1 CHILD LEFT WITHOUT SUPERVISION DURING INSPECTION IN THE CLASSROOM. THIS WAS BROUGHT TO THE DIRECTOR'S ATTENTION LPA VERIFIED THAT ALL STAFF HAS CURRENT CPR/1ST AID TRAINING CARDS. A PHYSICAL CENSUS WAS TAKEN OF ALL CHILDREN PRESENT AND CROSSED REFERENCED WITH THE SIGN/OUT SHEETS. 1 CHILD HAS NOT BEEN SIGNED IN TODAY.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ANGELS MONTESSORI PRESCHOOL - CONCORD	FACILITY NUMBER: 073402302
	VISIT DATE: 10/27/2022

NARRATIVE

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A SAMPLE OF CHILDREN'S RECORDS WERE REVIEWED. FILES REVIEWED CONTAINED EMERGENCY INFORMATION AND CURRENT IMMUNIZATION RECORDS. STAFF RECORDS REVIEWED HAVE REQUIRED HEALTH SCREENING. TEACHERS PRESENT TODAY MEET QUALIFICATION REQUIREMENTS.

Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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: ANGELS MONTESSORI PRESCHOOL - CONCORD	FACILITY NUMBER: 073402302
	VISIT DATE: 10/27/2022

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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.

As a result of this visit, there are no deficiencies cited today. An exit interview was conducted. A notice of site visit was posted.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 10/27/2022 03:39 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: ANGELS MONTESSORI PRESCHOOL - CONCORD	FACILITY NUMBER: 073402302
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229(a)(1)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY: TODAY 1 CHILD WAS OBSERVED IN THE CLASSROOM WITHOUT ADULT SUPERVISION
	POC Due Date: 11/10/2022
	Plan of Correction
1 2 3 4	LICENSEE WILL IMMEDIATELY ENSURE ALL CHILDREN ARE VISUALLY SUPERVISED AT ALL TIMES. LICENSEE WILL CONDUCT A TRAINING ON SUPER VISION WITH STAFF AS STATED ON COMPLAINT CITATION AND SUBMIT PROOF OF TRAINING/SUMMARY AND SIGN IN SHEET TO COMMUNITY CARE LICENSING BY 11/10/22

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: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

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