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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506275
Report Date: 07/17/2024
Date Signed: 07/17/2024 04:10:04 PM


Document Has Been Signed on 07/17/2024 04:10 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:MARIA MONTESSORI SCHOOL OF THE GOLDEN GATEFACILITY NUMBER:
380506275
ADMINISTRATOR:ALAVI, TARANEHFACILITY TYPE:
850
ADDRESS:62 LENOX WAYTELEPHONE:
(415) 731-8188
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY:24CENSUS: 23DATE:
07/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Director, Taraneh AlaviTIME COMPLETED:
04:25 PM
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On 7/17/2024, at approximately 1:10PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Director Taraneh Alavi (D1) and explained the purpose of the visit. Present during the visit was D1, two staff members, and 23 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:00AM to 5:30PM.

LPA and D1 inspected the facility for any health or safety hazards. The facility is equipped with fully charged 2A10BC fire extinguishers. There are operational carbon monoxide detectors present in the facility. There is a fire alarm system running throughout the facility. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care.

LPA observed there to be age-appropriate toys and learning materials for children. Children have access to books, manipulatives, and art supplies. Furniture is age-appropriate and free of rough or sharp edges. The floors and surfaces of the facility were observed to be clean and free of debris. LPA observed waste bins to be fitted with tight-fitting lids. Children place their belongings on hooks that are labeled with their names. Per D1, children bring lunch from home and the facility provides AM/PM snacks. Children bring water bottles from home and refill them at the facility as necessary. Per D1, children nap on mats that are provided by the facility. Children bring bedding from home and take it back once a week for cleaning.

LPA observed two toilets and two sinks available for use by children. Toilets were demonstrated to be operational during the visit.



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SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan TseTELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024
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 15


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARIA MONTESSORI SCHOOL OF THE GOLDEN GATE
FACILITY NUMBER: 380506275
VISIT DATE: 07/17/2024
NARRATIVE
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The outdoor play area of the facility was observed to be free of debris and other loose articles. Age-appropriate toys and equipment are available for use. There are no play structures present. There is cushioning available in the form of artificial turf. There are no pools or other similar bodies of water present in the facility. The outdoor play area is enclosed by a fence that is at least four feet high. Per D1, there are no weapons or firearms stored in the facility.

LPA reviewed four staff files, five children’s files, and facility records. LPA observed D1’s qualifications to be available for review. D1’s Mandated Reporter Training expires 12/2026.

LPA observed that a staff member, S1, did not have fingerprint clearance or association to the facility during record review. LPA notified D1 and S1 left the facility to get fingerprinted during the visit. LPA informed D1 that S1 was not to return to the facility until they had acquired fingerprint clearance. D1 stated that they understood. Additionally, D1 was informed that a Type A citation and a civil penalty of $100 would be issued today. D1 stated that they understood. LPA discussed forms LIC9163 and LIC9182.

LPA observed children’s files to contain Emergency Identification and Information (LIC700). LPA referred D1 to the Entrance Checklist – Child Care Centers (LIC125) during the visit. D1 was advised to use the most current licensing forms that were listed on the checklist. D1 stated that they understood.

LPA observed all required postings to be posted and accessible for review. Per D1, the last emergency drill was conducted in 6/2024. LPA advised that all emergency drills shall be logged and documented. D1 stated that they understood.

Based on record review of the lead sampling database, LPA observed that lead water testing has not been conducted at the facility. LPA discussed lead water testing requirements with D1 during the visit. Per D1, the sink in the facility is not used for food preparation or drinking water. The facility receives deliveries of filtered water monthly. LPA advised that an attestation stating that the facility does not use any fixtures for food preparation or drinking water shall be submitted. D1 stated that they understood.


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SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan TseTELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARIA MONTESSORI SCHOOL OF THE GOLDEN GATE
FACILITY NUMBER: 380506275
VISIT DATE: 07/17/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a
maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.



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SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan TseTELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC809 (FAS) - (06/04)
Page: 3 of 15
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MARIA MONTESSORI SCHOOL OF THE GOLDEN GATE
FACILITY NUMBER: 380506275
VISIT DATE: 07/17/2024
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Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

See LIC809-D for deficiencies cited today regarding fingerprint clearance and lead water testing. See LIC9102-TV for technical violations issued today regarding staff and children’s records. See LIC9102-TA for technical assistance provided regarding staff and children’s records. Appeal rights were provided and explained to D1. A notice of site visit was given and must remain posted for 30 days.

LPA Tse informed facility representative Taraneh Alavi that this report dated 7/17/2024 documents one Type A citation which shall be posted for 30 consecutive days as there was immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Tse informed the facility representative to provide a copy of this licensing report dated 7/17/2024 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the facility representative Taraneh Alavi.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan TseTELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC809 (FAS) - (06/04)
Page: 4 of 15
Document Has Been Signed on 07/17/2024 04:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: MARIA MONTESSORI SCHOOL OF THE GOLDEN GATE
FACILITY NUMBER: 380506275

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by not having S1 fingerprinted which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2024
Plan of Correction
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D1 had S1 leave the facility to get fingerprinted. S1 returned and provided the receipt as proof. D1 was informed that S1 could not return until they acquired fingerprint clearance. D1 asked S1 to leave the facility until then. S1 complied and left.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan TseTELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024
LIC809 (FAS) - (06/04)
Page: 5 of 15


Document Has Been Signed on 07/17/2024 04:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: MARIA MONTESSORI SCHOOL OF THE GOLDEN GATE
FACILITY NUMBER: 380506275

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by not testing fixtures for lead or submitting an attestation before the deadline of 1/1/2023 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/16/2024
Plan of Correction
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D1 shall submit an attestation stating that the facility does not use fixtures for food preparation or water consumption by set due date of 8/16/2024. D1 was advised to attach any and all supporting documentation regarding water services.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan TseTELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024
LIC809 (FAS) - (06/04)
Page: 6 of 15