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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410505759
Report Date: 01/10/2022
Date Signed: 01/10/2022 04:33:48 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:CREATIVE MONTESSORI LEARNING CENTERFACILITY NUMBER:
410505759
ADMINISTRATOR:MARSHALL, GLORIA J.FACILITY TYPE:
850
ADDRESS:1421 BAY ROADTELEPHONE:
(650) 325-9543
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:120CENSUS: 27DATE:
01/10/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Ce Cole Dillon and Dileepa ZarateTIME COMPLETED:
03:45 PM
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On January 10th, 2021 at 1:30pm, Licensing Program Analyst (LPA), Tapia-Mandujano conducted an unannounced inspection for the plan of correction (POC) inspection regarding the substantiated complaint. LPA met with a member of the Board, Ce Cole Dillon and interim Site Supervisor, Dileepa Zarate. The purpose of the inspection was explained.

On 12/07/21, the following deficiency were cited during a complaint investigation. Facility did not comply with Title 22 Regulations, Section 101170(e)(1) and 101215.1(b). Facility had un-fingerprinted and un-associated adults present in the facility. Also, facility did not have a qualified Director/Site Supervisor on site.

Deficiencies cited on 12/07/21 were cleared today.

During today's inspection (1/10/22), LPA received the following documents for New Interim Site Supervisor, Dileepa Zarate. Director packet was almost complete, just pending completion of trainings.

No citations were cited today under Tittle 22 regulations.

An Notice of Site Visit shall be posted in a prominent place in facility for 30 days. Failure to maintain posting as required will result in a civil penalty of $100.

Report was reviewed and discussed with Board Member, Ce Cole Dillon and Interim Site Supervisor, Dileepa Zarate. A copy of this report was emailed to the facility at info@cmlcepa.org. Signed copy of this report will be kept in the facility file and made available for public review. Desk Duty is available Monday through Friday between 8:00 AM - 5:00 PM at (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Leslit Tapia-MandujanoTELEPHONE: (650) 350-2554
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
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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