414001981-10-8-2019-05-CC-MROZ-BGRP6A-20191008110201

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414001981
Report Date: 10/08/2019
Date Signed: 10/08/2019 11:02:23 AM

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:	KINDER ACADEMY MONTESSORI		FACILITY NUMBER:	414001981
ADMINISTRATOR:	MA, SOPHIA SHAN		FACILITY TYPE:	850
ADDRESS:	300 E. SANTA INEZ AVENUE		TELEPHONE:	(650) 340-8819
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	24	CENSUS: 19	DATE:	10/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Sophia Ma		TIME COMPLETED:	11:15 AM

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	Licensing Program Analyst (LPA) Marie Rodriguez made an unannounced Annual Random inspection. LPA met with Director Sophia Ma and explained purpose of inspection. Present at facility were the Director, 3 teachers, and 19 children (preschool age). Center is operating within capacity limits and in compliance with staff to child ratio. Hours of operation are Monday to Friday from 8:00am to 6:00pm. Center provides a half day and a full day program. LPA toured and inspected center with Director. There are no bodies of water, firearms, or weapons on the premises. Both classrooms in center are in good condition with proper temperature and ventilation and are free of any hazards. Furniture in classrooms are in good repair. Classrooms have age appropriate toys and equipment. Each classroom has a wall heater that is properly barricaded. Napping mats are in good condition and are properly stored in main classroom. There are two bathrooms adjacent to main classroom. The boys bathroom has one toilet, urinal, and sink. The girls bathroom has one toilet and sink. Bathrooms appear to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage in the adjoining church. The outdoor play area is fenced for supervision with age appropriate toys and equipment in good condition. The play structure is age appropriate and in good condition with sufficient cushioning underneath. All required postings and waiver are posted on the bulletin board by the main classroom. Menu is posted for the month. Center only provides morning and afternoon snacks. Children bring their own lunch. Drinking water is available for children indoors and outdoors. Food preparation area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. All cleaning products, chemicals, and toxins are inaccessible to children. (Continued on second page)

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

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: KINDER ACADEMY MONTESSORI	FACILITY NUMBER: 414001981
	VISIT DATE: 10/08/2019

NARRATIVE

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(Continued from first page)

Incidental Medical Services (IMS) was discussed with Director. There is an IMS plan in place but there are no children receiving services during this school year. Last emergency drill was conducted on September 25, 2019. Emergency drills are conducted every other month and are properly logged. The center has a complete record of sign-in/out sheets by authorized pickup person. There is a working fire alarm system on site. Each classroom has a working smoke and carbon monoxide detector. There is a fully charged fire extinguisher, a first aid kit, and a working telephone available.

Five children records reviewed were complete. All children have a record of emergency identification information on file. Three staff records reviewed were complete. All staff have a criminal record clearance on file. All staff have current Pediatric First Aid/CPR certificates on file which expire on April 2020.

During inspection,
· Director was reminded, as of September 1, 2016, all Staff and Volunteers must provide proof of immunization against pertussis, measles, and influenza, or qualifies for an exemption, pursuant to Health and Safety code 1596.7995 and 1597.662.
· Director was informed about Mandated Reporter Training available on CCLD website. Training must be completed by staff every two years. (Websites: www.ccld.ca.gov or www.mandatedreporterca.com).
· Director was informed about San Mateo Child Care Center Stakeholder's Meeting on Friday, November 1, 2019 and was given a paper invitation to the meeting.
· Director was reminded about the Provider Information Notices (PINs) on CCLD website.

No deficiencies cited today.

This report was reviewed and discussed with Director Sophia Ma. A copy of report was provided.
Notice of site visit was observed being posted and shall remain posted for 30 days.

Any additional questions, call San Bruno CCLD Office, Monday - Friday, 8am - 5pm, (650) 266-8800 or 1 (844) 538-8766. Website: www.cdss.ca.gov.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

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