073408869-9-20-2019-02-CC-WNOA-BG7PCW-20190920111238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408869
Report Date: 09/20/2019
Date Signed: 09/20/2019 11:12:56 AM

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:	KEYSTONE MONTESSORI SCHOOL		FACILITY NUMBER:	073408869
ADMINISTRATOR:	PATHAK, ROHINI		FACILITY TYPE:	850
ADDRESS:	6639 BLAKE STREET		TELEPHONE:	(510) 709-5853
CITY:	EL CERRITO	STATE: CA	ZIP CODE:	94530
CAPACITY:	57	CENSUS: 33	DATE:	09/20/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rohini Pathak		TIME COMPLETED:	11:30 AM

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	A Prelicensing visit was conducted today, September 20, 2019 by Licensing Program Manager (LPM) Wynn Norona. LPM met with applicant/director Rohini Patak. The applicant has submitted an application for Change of Ownership. This is a Preschool program with 12 Toddler-Option (18 months to 36 months). The operating hours is Monday through Friday from 7:30am to 6pm. There are 25 preschoolers, 7 toddlers with 9 fingerprint cleared staff present during the inspection. A health and safety inspection was conducted inside and outside and the measurements are as follows: INDOORS: 2099.4 square feet = 60 children OUTDOORS: 3787.69 square feet = 50 children The center has obtained an approved fire inspection clearance from El Cerrito Fire Department on 8/29/19. There are two rooms (Snowy Egret and Blue Heron) for the Preschool program and one room (Sandpiper) for the Toddler-Option. The center is equipped with varied age appropriate materials and equipment. There are 4 toilets and 6 sinks available for children. The office and the staff toilet will serve as isolation areas for sick children. There is a kitchen inaccessible to the children where the snacks and medication will be stored. There are cots which will be utilized for napping. There are smoke detectors, carbon monoxide detector, fire extinguishers available all throughout the center. Water is available inside and outside. Outdoor play area is properly fenced. A waiver for outdoor activity area was requested to allow no more than 50 children at a time. A waiver for electronic sign in/out was also submitted during the inspection. Licensing posting is properly posted for the parents and the public. This facility plans to provide Incidental Medical Services – IMS. A copy of the IMS plan of operation was submitted during the visit. 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: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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 2

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: KEYSTONE MONTESSORI SCHOOL	FACILITY NUMBER: 073408869
	VISIT DATE: 09/20/2019

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
26
27
28
29
30
31
32

Rohini Pathak is a fully-qualified preschool director and has completed 16 hours of health and safety training including pediatric CPR and First Aid which expires on 2/2/21. Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Director was also informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair. An exit interview was conducted with applicant, Rohini Patak.

A license for 57 preschool children which includes 12 Toddler-Option is recommended pending the approval of waiver requests, submission of personnel policy and applicant's application orientation certificate

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2