380501318-10-19-2022-05-CC-NGAA-CKCUWQ-20221019155707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 380501318
Report Date: 10/19/2022
Date Signed: 10/19/2022 03:57:14 PM

Document Has Been Signed on 10/19/2022 03:57 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MONTESSORI HOUSE OF CHILDREN		FACILITY NUMBER:	380501318
ADMINISTRATOR:	DIANA GUSTAFSON		FACILITY TYPE:	850
ADDRESS:	1187 FRANKLIN STREET		TELEPHONE:	(415) 441-7691
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94109
CAPACITY:	110	CENSUS: 44	DATE:	10/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:38 PM
MET WITH:	Yasha Nasiripour		TIME COMPLETED:	04:00 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 October 19, 2022 at approximately 01:45PM, Licensing Program Analyst (LPA) Garcia met with Director, Yasha Nasiripour for an annual inspection and in conjunction with complaint investigation. Purpose of the inspection was explained. Present, in the facility are Director, 11 teachers supervising 44 children. Facility is operating within its capacity and is in compliance with staff/child ratio on this day. Facility operates day care from Monday - Friday 8:00am to 5:30pm. With Director, LPA inspected the day care rooms and outdoor space. LPA observed facility has smoke detectors combined carbon monoxide detectors, 2 fully charged fire extinguisher model 3A40BC located on multiple areas of the facility with working telephone on site. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards. There are first aid supplies available in each classrooms and in the office. All bathrooms are in working condition. All food is stored properly to avoid contamination. Facility has enough sleeping cots available and provides sheet/blankets from home. Individual items provided by the parents are labeled and stored appropriately. Two AM/PM snacks and lunches are brought from home with their water bottles. Water is provided through purchased bottled water, as needed. All foods must be nut-free and food preparation area is free of litter. Food is stored adequately to prevent contamination and properly labeled. Facility uses a schedule in the outdoor yard for play. There is water available for children in the yard as well as in the classrooms and emergency bags. There were no hazards and large play structures are stable and age appropriate with a slide. Outdoor toys are kept in a covered bin/chest when not in use. There are two outdoor play areas with age appropriate structures and toys. *page 2 for continuation*

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

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 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: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 380501318
	VISIT DATE: 10/19/2022

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

***Page 2 continued***

LPA observed that facility is using Brightwheel sign in / out. Facility has license and all other required documents posted and visible for the public. Facility has an emergency drill log and last drill was conducted on Septmeber 21, 2022. Per Director, drills are done every month.

The LPA reviewed the facility records. LPA reviewed 5 random children's files. LPA reviewed 5 random staff files with qualifying requirements such as ECE Units and CPR and Mandated Reporter Trainings. All files reviewed were present in everyone’s folder. The facility has a set learning curriculum that includes story time, and movement posted in each classrooms. The special medications are kept in a locked box, including allergy medications and EpiPens.

The Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption or transfer their existing clearance or exemption prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare 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.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

***Page 3 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

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: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 380501318
	VISIT DATE: 10/19/2022

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

***Page 3 Continuation***

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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
>No deficiencies were cited today under CCR, Title 22, Division 12, Chapter 3. This report must be available in the facility for public review. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

Report was reviewed and signed by director, Yasha Nasiripour. Today’s report, and notice of site visit will be printed and given to the director.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 379-9023
LICENSING EVALUATOR NAME: Nathan Garcia	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3