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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407437
Report Date: 07/12/2023
Date Signed: 07/12/2023 05:18:34 PM


Document Has Been Signed on 07/12/2023 05:18 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:PATTY'S MONTESSORI SCHOOLFACILITY NUMBER:
073407437
ADMINISTRATOR:MAYBERRY, REBECCAFACILITY TYPE:
850
ADDRESS:801 PARK CENTRAL STTELEPHONE:
(510) 223-0314
CITY:RICHMONDSTATE: CAZIP CODE:
94803
CAPACITY:45CENSUS: 26DATE:
07/12/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:MAYBERRY, REBECCATIME COMPLETED:
05:00 PM
NARRATIVE
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On 07/12/23 at 08:45AM Licensing Program Analyst (LPA) Nyeesha Blount conducted a unannounced Case management for Lead Testing/ exceedance at Patty's Montessori School. LPA met with Director Mayberry,Rebecca and explained the purpose of today's inspection.

LPA toured the facility for a health and safety check. The water fountain outside in the play yard entrance exceeded the acceptable amount of lead allowed in a child care center. The director stated that facility has not used drinking fountain outdoor since pre covid 2020 and will be permanently ceased. the drinking fountain is currently bagged and taped up made inaccessible to children in care.

The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director Mayberry, Rebecca.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
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 07/12/2023 05:18 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: PATTY'S MONTESSORI SCHOOL
FACILITY NUMBER: 073407437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2023
Section Cited

101700.3

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Licensee shall maintain a lead value at or below the Action Level of 5 ppb in all outlets subject to the testing requirements of these Written Directives, for the health and safety of children in care.
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The facility will currently cover drinking fountain so it made inaccessible to children in care. Director stated they will permanently cease the drinking fountain. POC date of August 12, 2023
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Based on record review the licensee did not comply with the section cited above as there was a drinking foutain outdoor had a lead exceedance, which poses a potential Health and Safety risk to persons 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: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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