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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402552
Report Date: 02/04/2020
Date Signed: 02/04/2020 03:28:18 PM

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:CREEKSIDE MONTESSORIFACILITY NUMBER:
073402552
ADMINISTRATOR:AMY BEATYFACILITY TYPE:
850
ADDRESS:1333 ESTUDILLOTELEPHONE:
(925) 228-5718
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:30CENSUS: 18DATE:
02/04/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:TITUS, NICOLE, TEACHER, BEATHY, AMY, LICENSEETIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Redmond, arrived at the facility to conduct a health and safety inspection. The purpose of the inspection is to ensure the Child Care Center facility is in compliance with Title 22, CCR and Health and Safety Code Statutes. During the inspection, LPA met TITUS, NICOLE, TEACHER. The Director, BEATY, AMY, came later during the visit. During the inspection, the LPA made the following observations:

The Child Care Center facility is licensed for ages 2 years to first grade. There are 27 children present and two teachers. Children are napping. The facility is in compliance with teacher to child ratios and capacity restrictions.

· Classroom (3): Furniture and equipment is age appropriate and in good repair.

· Restroom: Are clean, have working toilets and sinks, toilet paper and paper towel.

· Play yard: There are no observable health or safety hazards. There are age appropriate toys and equipment. There is drinking water readily available and a shaded area for the children.

Emergency Preparedness/Safety: Smoke detector is attached throughout the facility and is tested by a professional company. LPA reviewed inspection tag, detectors were tested on 09/29/19. The fire extinguishers are fully charged and were inspected during the fire alarm inspection. First aid supplies available. Emergency Disaster Plan is dated 02/03/20 and is current, per Director. Fire and earthquake drills were last conducted on 09/19/19 and meet six (6) month requirement. The facility utilizes a land line. The facility is currently providing
CONTINUED
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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 3
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: CREEKSIDE MONTESSORI
FACILITY NUMBER: 073402552
VISIT DATE: 02/04/2020
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*Incidental Medical Services (IMS) for any of the infants in care and is aware of IMS requirements.

Training/Record Review:
Director and all adults employed at the facility have criminal background clearances and are associated to the facility. Director and staff’s CPR/First Aid have expired on 07/2017. Director and staff persons, have completed Mandated Reporter training on have certifications which expire in 03/20. Facility does not provide care and supervision to infants.

Posted: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist. If You See Something, Say Something.

Staff Immunization: Director and staff have immunization records on file including tuberculosis.

Overall, the facility is clean, orderly and in good repair. The temperature is comfortable and there is adequate heating and ventilation. There are safe, healthful and comfortable accommodations, furnishings and equipment. There are no cleaning solutions, medications, toxins or other hazardous items accessible to children. There are no pools, hot tubs or other bodies of water present.

Facility Evaluation Report discussed with the Director and signature obtained below. A copy of this report shall be maintained for 3 years and available for public review upon request

Notice of Site Visit was issued and shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty.

SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CREEKSIDE MONTESSORI
FACILITY NUMBER: 073402552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2020
Section Cited

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Personnel Requirements
At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid..See section cited. THIS REQUIRMENT WAS NOT MET
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 ALL STAFF'S CPR/FIRST AID HAVE EXPIRED ON 7/2017. THIS POSES A POTENTIAL THREAT TO THE HEALTH AND SAFETY OF CHILDREN IN CARE.
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TO COMPLETE POC BY POC DUE DATE MAY RESULT IN CIVIL PENALTY ASSESSMENT OF $100 PER DAY, PER VIOLATION.

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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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3