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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380501318
Report Date: 10/28/2019
Date Signed: 10/28/2019 02:28:38 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:MONTESSORI HOUSE OF CHILDRENFACILITY NUMBER:
380501318
ADMINISTRATOR:DIANA GUSTAFSONFACILITY TYPE:
850
ADDRESS:1187 FRANKLIN STREETTELEPHONE:
(415) 441-7691
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94109
CAPACITY:110CENSUS: 49DATE:
10/28/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Diana Gustafson and Lauren PayumoTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Mok conducted the case management for the incidents today. LPA met with the Site director, Diana Gustafson and Lauren Payumo. The purpose of the inspection was explained to them. There were 49 children with 10 staff present. The case management was related to the unusual incident reports that were submitted by the licensee on 2/28/2019 and 7/11/2019. The report that was submitted on 2/28/19 about 3 classrooms had water leaking and mold issues. Therefore, the facility moved the children in the affected rooms to other rooms with clean air for health and safety. The children already moved back to the original classrooms after the repair by the end of July 2019. LPA also inspected the rooms during the inspection. The rooms were fine. LPA didn't observe any issue in the rooms.

The report that was submitted on 7/11/2019, it was about a child showed his arm with a bug bite to a teacher during the bathroom time on 7/8/2019. The child also claimed he got it over the weekend. The teacher also reminded him to inform his parents about it. However, the parent informed the facility about his son was on the way to emergency because he got a spider bite at school on 7/9/2019. Facility did internal investigation on the issue. Per a teacher who saw the bite on his arm on 7/8/2019, it looked like a mosquito bite. The teacher also mentioned the child told her he got it at home. The facility hired Pest control to clean up the classrooms to make sure it's safe for the children. The facility also submitted a copy of the invoice from the Pest Control Company to prove the work that was done by them on 7/12/19. The classrooms are free of insect now.

*No deficiency was cited during the inspection today.


This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019
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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