214005482-6-23-2021-05-CC-FBTQ-C4A39G-20210623180306

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005482
Report Date: 06/22/2021
Date Signed: 06/23/2021 06:03:42 PM

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:	ACQUA MONTESSORI SCHOOL		FACILITY NUMBER:	214005482
ADMINISTRATOR:	NICOLAS RYAN MENDOZA		FACILITY TYPE:	850
ADDRESS:	8 N SAN PEDRO RD		TELEPHONE:	(415) 755-7075
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	24	CENSUS: 11	DATE:	06/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Nicolas Ryan Mendoza		TIME COMPLETED:	01:20 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	* This report was prepared in CCLD Regional Office ,San Bruno due to COVID-19 restrictions. Facility inspection was conducted on 6/22/21. Director was informed that a copy of this report will be emailed to him by close of business on Wednesday 6/23/21 * Licensing Program Analyst (LPA), Farhan Bashir-Tariq arrived at the facility above unannounced and met with Director , Nicolas Ryan Mendoza, for a required one-year inspection. Purpose of inspection was explained. There were 11 children present today with four teachers including Director. Facility is operating within the capacity and is following staff child ratio on this day. LPA verified that the background check clearances of all teachers present today were already on file. Facility operates day care from Monday to Friday between 7:00 AM to 6:00 PM. Prior to this on-site inspection, risk assessment was completed with Director to identify any COVID risks. No risks were identified. LPA along with Director inspected the facility indoors and outdoors for health and safety hazards. LPA inspected the main classroom. Classroom was clean and orderly with plenty of toys, books and other learning materials available for children in care. Children's bathroom is available in the classroom. A second bathroom for children and an adult bathroom for staff is located in hallway. Bathroom were maintained clean, in good repair, and with adequate supplies. All toilets and hand washing equipment were in working condition with proper sanitation in place. Poster for hand washing were observed to be posted in bathrooms. Storage closets located in the hallway have been secured with safety covers. Per Director, there are no pools, spas or other bodies of water at the facility. Facility has a smoke detector, a carbon monoxide detector and a working telephone available at the site. Per Director, there are no firearms or weapons present at the facility. Fire extinguisher of 2A10BC or bigger was observed in hallway kitchen and classroom. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. LPA observed the back yard. All of the play structures were steady, in good repair and free of any loose parts. Water fountain was available in the play yard for drinking water. Cubbies were available for children to store their belongings. Page... 1 of 2

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021

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

FACILITY NAME: ACQUA MONTESSORI SCHOOL	FACILITY NUMBER: 214005482
	VISIT DATE: 06/22/2021

NARRATIVE

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All posting requirements were met. License, parent’s rights poster, emergency disaster plan and all other required licensing documents were observed to be posted by facility's main door. Posters for COVID-19 symptoms, masks and other important information were observed to be posted. Masks, sanitizers and cleaning wipes were available in the facility. Staff present today met the requirement of wearing masks. LPA reviewed facility records. LPA reviewed six random children's files. LPA reviewed all staff's files present today. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Each child's record contains the record immunization. Multiple staff members have record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers.

LPA reminded the facility 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 or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reminded the facility, As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA encouraged the facility to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates

> Type B deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations :See LIC 809D.

This report and rights to comment and appeal were discussed with Director. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from the date of visit. Facility was advised for any additional questions to call office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov
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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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

FACILITY NAME: ACQUA MONTESSORI SCHOOL	FACILITY NUMBER: 214005482
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/22/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/07/2021 Section Cited	1 2 3 4 5 6 7	1596.8662 (b) (1)...On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by record reviews and interviews. None of the staff present today had a valid certificate for child abuse training. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Director will submit proof of completion for himself and all staff to LPA via email by due date of 07/07/21.
Type B 07/07/2021 Section Cited	1 2 3 4 5 6 7	1596.866 (b) Day care center directors and licensees of family day care homes shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority pursuant to this section and Section 1797.191 shall be onsite at all times when children are present at the facility, and shall be present with the children when children are offsite from the facility for facility activities. Nothing in this subdivision shall be construed to require, in the event of an emergency, additional staff members, who are onsite when children are present at the facility, to have a current course completion card in pediatric first aid and pediatric CPR.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by record reviews and interviews. None of the staff present today had a valid CPR card present at the facility. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14

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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC809 (FAS) - (06/04)

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