384002088-5-16-2024-05-CC-JTSE-D5BUA4-20240516152407

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002088
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:24:22 PM

Document Has Been Signed on 05/16/2024 03:24 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:	SFUSD - PUBLIC MONTESSORI SCHOOL (EES)		FACILITY NUMBER:	384002088
ADMINISTRATOR:	KEENER, LINDSEY		FACILITY TYPE:	850
ADDRESS:	2340 JACKSON STREET		TELEPHONE:	(415) 749-3544
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94115
CAPACITY:	88	CENSUS: 32	DATE:	05/16/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Principal, Monette Benitez		TIME COMPLETED:	03:35 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 5/16/2024, at approximately 12:40PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Principal, Monette Benitez (D1). LPA explained the purpose of the visit. Present during today’s visit were D1, six staff members, and 32 preschool age children. The facility is in compliance with staffing and ratio requirements on this day. LPA inspected the facility for any health or safety hazards. San Francisco Public Montessori contains a pre-K program and an elementary school program. LPA observed the facility to be in clean and orderly condition. The facility operates in Rooms 111 and 112. The facility is equipped with fully charged fire extinguishers that are at least size 2A10BC. There is a fire alarm system running throughout the facility. Each room has a carbon monoxide detector. Electrical outlets are covered when not in use to be inaccessible to children in care. Both classrooms are equipped with age-appropriate furniture that are free of rough or sharp edges. There are age-appropriate learning materials and toys for children in care. There are covers for waste bins to mitigate the presence of rodents. There are two toilets and two handwashing sinks in each classroom. There are cubbies available for each child that are labeled. Cots are provided for napping that are also labeled with each child’s name. Children bring bedding from home and take it back once a week for cleaning. The facility provides food for children in care, but children have the option of bringing lunch from home. Water is available for children in care from non-contaminating fixtures. Continued on Page Two

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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

FACILITY NAME: SFUSD - PUBLIC MONTESSORI SCHOOL (EES)	FACILITY NUMBER: 384002088
	VISIT DATE: 05/16/2024

NARRATIVE

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LPA observed the outdoor play area to be free of debris and other loose articles. There is an age-appropriate play structure intended for use by children from the ages of two to five years. The play structure is cushioned by resilient padding. The outdoor play area is enclosed by a fence. The outdoor play area is used by one classroom at a time. There are no pools or other bodies of water present in the facility.

LPA reviewed five staff files, six children’s files, and facility records. LPA observed there to be at least one staff member present with current Pediatric First Aid/CPR training. Staff members have current Mandated Reporter Training. Qualifications and immunization records are available for review. LPA advised that D1 shall complete their file and maintain it available for review. LPA observed all children’s files to be complete, including Emergency Identification and Information (LIC700) and Consent for Emergency Medical Treatment (LIC627). All required postings are posted and accessible for review. Sign-in/out sheets are present in each classroom.

The facility tested its fixtures for lead on 8/6/2022 before the deadline of 1/1/2023. There were no exceedances of lead in any of the tested fixtures.

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.

Continued on Page Three

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: SFUSD - PUBLIC MONTESSORI SCHOOL (EES)	FACILITY NUMBER: 384002088
	VISIT DATE: 05/16/2024

NARRATIVE

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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 verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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-carecenters/.

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.

No deficiencies were cited during today’s visit on 5/16/2024. See LIC9102-TV for technical violation given today.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Marilyn Dunn.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Jonathan Tse	TELEPHONE: (650) 464-4927
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

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