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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004021
Report Date: 04/22/2022
Date Signed: 04/22/2022 05:15:03 PM


Document Has Been Signed on 04/22/2022 05:15 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:CREATIVE MONTESSORI PRESCHOOLFACILITY NUMBER:
384004021
ADMINISTRATOR:YANG, YANGFACILITY TYPE:
850
ADDRESS:3101 VICENTE STREETTELEPHONE:
(415) 661-2828
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94116
CAPACITY:52CENSUS: 39DATE:
04/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Yang YangTIME COMPLETED:
05:15 PM
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 On April 22, 2022, Licensing Program Analyst (LPA) Van met with Director Yang Yang for an unannounced annual random inspection. The purpose of the inspection was explained and granted entry to the facility by the Director. Senior Director Nicole Olsen arrived during the inspection. Present today are 39 children supervised by six staff. The facility complies with the staff-children ratios today. The days and operations hours are Monday - Friday from 7:30 am to 6:00 pm.
LPA toured and inspected the physical plant for any health and safety hazards. The facility has an electronic sign-in /out for parents or authorized representatives; sign-in/out codes are provided to the parents. The facility is in good repair and has proper temperature and ventilation. There are varieties of age-appropriate toys and learning materials. Furniture appears steady and in good repair. The facility has a carbon monoxide detector, centralized smoke alarms, fully charged fire extinguishers, and working telephones. LPA observed that each child has their cubbies available with their name labeled. All emergency supplies are stored in locked storage. Medications are appropriately labeled and stored out of reach of children. LPA reviewed and discussed the facility's Incidental Medical Services Plan with the Director. First aid supplies are fully stocked and available for children's usage. All cleaning solutions, poisons, and other dangerous chemicals are stored in an area inaccessible to children. Sleeping cots are appropriately stored.
The facility has a total of four toilets and four sinks for children, and there is a separate toilet for staff usage; all toilets and sinks are in safe and sanitary operating conditions. The outdoor play area is completely fenced, clean, and in good repair. Outdoor play structures are age-appropriate, good condition, and free of loose parts. Climbing structures are securely anchored, and there is soft cushioning underneath all play structures to absorb accidental falls. Director states the staff has water pitchers available for children indoors and outdoors. LPA observed no bodies of water on the premises.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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: CREATIVE MONTESSORI PRESCHOOL
FACILITY NUMBER: 384004021
VISIT DATE: 04/22/2022
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 The facility had posted the required forms. (i.e., License, waivers, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, Emergency Disaster Plan, and Daily activities). Per the Director, the Center provides snacks, breakfast, and lunch for children. The menu is observed posted. The food preparation area is adequately equipped, clean, and free of hazards; this area is made inaccessible to children. All storage containers for solid waste within the Center have a proper tight-fitting cover.
Ten random children's records and personnel records were reviewed during the inspection. Records review showed the facility has records of each child's authorized representative's names, addresses, and telephone numbers. In addition, each child's immunization record, medical assessment, and admission agreement can be located in each child's file. Staff records indicate that all staff or other individuals who require caregiver background checks have received criminal records and child abuse index clearances or exemptions. Multiple staff members have a record of valid CPR. All staff maintained immunization records and verified the mandated child abuse reporting training as compliant with AB1207. LPA reviewed the educational qualification of the Director and staff, and all staff had the required ECE units. The Director stated that the Center conducts fire and earthquakes monthly, and the last drill was conducted on March 14, 2022.
The incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
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.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
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: CREATIVE MONTESSORI PRESCHOOL
FACILITY NUMBER: 384004021
VISIT DATE: 04/22/2022
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 The Director was informed about Mandated Reporter training available on the CCLD website. In addition to AB1207 training required to complete every two years by the Licensee and all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. Also, the Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
LPA encouraged the Director to frequently visit the Licensing website at www.ccld.ca.gov for licensing regulations and new updates. Director can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

During the inspection, LPA requested an up-to-date Emergency Disaster Plan (LIC 610), Personnel Report (LIC 500), and the Designation of Administrative Responsibility (LIC 308).

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
No deficiencies are cited today. An exit interview was conducted, and the Director reviewed the report. Today's report, April 22, 2022, and notice of site visit will be sent to the Director by email by the close of business on April 22, 2022. Confirmation of receipt is required. LPA informed the Director that the site visit notice must be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
LIC809 (FAS) - (06/04)
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