210111331-10-8-2019-05-CC-BVAN-BGRRR9-20191008131446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 210111331
Report Date: 10/08/2019
Date Signed: 10/08/2019 01:14:52 PM

COMPREHENSIVE INSPECTION

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MOUNTAIN SCHOOL, THE		FACILITY NUMBER:	210111331
ADMINISTRATOR:	GREY, LORI		FACILITY TYPE:	850
ADDRESS:	50 EL CAMINO DRIVE		TELEPHONE:	(415) 924-4661
CITY:	CORTE MADERA	STATE: CA	ZIP CODE:	94925
CAPACITY:	45	CENSUS: 33	DATE:	10/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Lori Grey		TIME COMPLETED:	01:30 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	On 10/08/19 at 11:30 A.M., Licensing Program Analyst (LPA) Van met with director, Lori Grey for an unannounced annual random inspection. The purpose of the inspection was explained, and was granted entry to the facility by the teacher. This is a preschool program, and the facility operates in two classrooms. Present today are 33 children with 5 teachers. Staff to children ratio are met. LPA observed that facility has sign in / out record with full legal signatures from parent or authorized representative. LPA reminded director to make sure that parents are sign in and out prior to drop off or pick up. Days and hours of operations are from Monday - Friday 8:00 AM - 6:00 PM. With director, LPA inspected the day care areas for health and safety hazards. The facility is in good repair, free of any hazards, and has proper temperature and ventilation. Variety of age appropriate toys and learning materials for children are available. Classroom is set up for child care; furniture, equipment, sufficient amount of sleeping mats for children are available. There are no pools, spas or other bodies of water at the facility. All bathrooms, toilets and sinks are clean and well sanitized. Per director, there are no firearms or weapons at the center. Facility has smoke detector and carbon monoxide combo detector, fully charged fire extinguisher and a working telephone at the site. All cleaning solutions, poisons and other chemicals that are dangerous stored inaccessible to children. Sick children will be separated from the group and will be waiting in the director's office for parents to pick up. Facility has water fountain and water bottle brought from child's home readily available. Per director, This center provides Incidental Medical Service (IMS), however, this current school year, facility does not have any child on IMS plan. Per director, the center provides morning and afternoon snacks, and lunch is brought from home. LPA observed the food preparation area is clean, and organize. Continue on the next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MOUNTAIN SCHOOL, THE	FACILITY NUMBER: 210111331
	VISIT DATE: 10/08/2019

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

Continuation from previous page...

The outside play area is completely fenced, clean and in good repair. The playground is free of hazardous materials. Play equipment is age appropriate, and safe. Climbing structures are securely anchored, free of any loose parts and has sufficient amounts of cushioning floor to prevent any fall injuries. There are no bodies of water, shade is provided for children, and the sand box is inspected daily. Drinking water is accessible by children's water bottle brought from home.

In the files that were reviewed, all children had a medical assessment, admission agreement and parents' rights form completed. In the staff files, all had criminal record clearance, personnel record, and a health screening with TB test. Multiple staff members have current Pediatric First Aid and CPR certification. Staff have the required immunization and verification of the mandated child abuse reporting training as compliant with AB 1207. LPA also observed facility has posted the required forms (i.e. License, menus, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Director stated Fire and Earthquake drills are done each month, last drill was logged on 9/11/19.

LPA reminded the director that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles.

LPA reviewed AB 1207 with the director. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2