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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001321
Report Date: 03/08/2022
Date Signed: 03/08/2022 04:59:01 PM


Document Has Been Signed on 03/08/2022 04:59 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 CHILDREN'S HOUSE-TULANE ROADFACILITY NUMBER:
414001321
ADMINISTRATOR:MONTE, MAUREEN M.FACILITY TYPE:
850
ADDRESS:315 TULANE ROADTELEPHONE:
(650) 342-0447
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:44CENSUS: 29DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Maureen MonteTIME COMPLETED:
05:10 PM
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On 3/8/2022 at 12:45P.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Maureen Monte. Purpose of the inspection was explained and was for an unannounced, annual inspection. Present was the director and 7 staff supervising 39 children. All children present had been properly signed in. Staff present had their criminal record clearances on file with the Department. Program utilizes two rooms: Upstairs and Downstairs Classrooms and the shared Outdoor Play Yard. Hours of operation are: Monday- Friday 815A.M.,-3:30P.M. Program offers both morning and afternoon cohorts/ part-day sessions. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

At 1:00 P.M., LPA observed the following: Classrooms were clean, orderly and had a variety of age-appropriate books, wood blocks and supplies for the children. Floor and ground surfaces were free of obstructions or hazards. All accessible furniture and playthings were in good repair. Each classroom was equipped with cubbies for storage of children's belongings. Classrooms had several child sized tables and chairs for activities. Fixtures in the children’s bathrooms were in proper operating condition. Bathrooms inspected had adequate supplies for the children. Staff bathroom is located on the upper level.

LPA reminded director to ensure children attending full day, are offered to napping option/ rest without distraction or disturbance. During inspection, Advisor Note: Technical Assistance (LIC9102) was issued to facility. Classroom had acceptable ventilation and lighting. Cleaning detergents, supplies, spray bottles and all other toxins were made inaccessible, stored in the upper cupboards. Outlets and trash bins had been properly covered. Facility has a functioning smoke detector, carbon monoxide detector and fully charged fire extinguishers (2A:10BC) located in each of the classrooms. First aid kit and emergency disaster supplies were reviewed during inspection. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022
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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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 CHILDREN'S HOUSE-TULANE ROAD
FACILITY NUMBER: 414001321
VISIT DATE: 03/08/2022
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(Page 2)

At 1:25P.M., LPA inspected the outdoor play area. Area was completely enclosed with tall fencing, and free of any debris or hazardous items. Outdoor playthings were inspected and in good repair. Water services are readily accessible for children with use of the drinking fountain. Climbing structure was properly anchored, and shaded rest area accessible to day-care children.

At 2:10P.M., LPA review the facility records including ten children’s files and eight personnel files. Children's files reviewed were complete, and included the required Health History (LIC702), Identification of Emergency Information (LIC700), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995) and Immunization Records.

Staff files were reviewed and included: Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), Transcripts and Notice of Employee Rights (LIC9052). Staff’s current mandated reporter training certifications were on file.

At 2:50P.M., Based on record review, LPA confirmed proof of required of the immunization were missing from staff files. During inspection, Advisory Note: Technical Assistance (LIC9102) was issued to facility.

All staff had a current CPR/ 1st aid certification, which will expire: 11/8/2022. Emergency drills had been conducted at the facility, with the last drill done, 1/27/2022, properly logged. Per director, families are providing daily meals for children in care. LPA reminded director to ensure any container brought from home are properly labelled with the child’s name.

All required posting had been posted, included facility’s License, Notification of Parents Rights (PUB393) and Emergency Disaster Plan (LIC610). During inspection, LPA reviewed children’s medication. Medications items reviewed were properly stored.

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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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 CHILDREN'S HOUSE-TULANE ROAD
FACILITY NUMBER: 414001321
VISIT DATE: 03/08/2022
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on today's inspection, no deficiencies were cited in areas evaluated, according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Director, Maureen Monte and her signature of this form acknowledges receipt of these documents.



Notice was provided and must remain posted for 30 days.

This report and rights to comment were discussed. This report must be available in the facility for public review. For additional questions, facility was advised to contact the Community Care Licensing Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5