<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002467
Report Date: 04/28/2022
Date Signed: 04/28/2022 01:00:46 PM


Document Has Been Signed on 04/28/2022 01:00 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:BERESFORD MONTESSORIFACILITY NUMBER:
414002467
ADMINISTRATOR:REGINA MASLOGFACILITY TYPE:
850
ADDRESS:1717-1719 GUM STREETTELEPHONE:
(650) 571-8749
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY:41CENSUS: 30DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Karina Garcia-BarberaTIME COMPLETED:
01:15 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 4/28/2022 at 8:45A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Karina Garcia-Barbera. Purpose of the inspection was explained and was for an unannounced, Annual/ Random inspection. Present was the Licensee and 5 staff supervising 30 children. All staff have their criminal record clearance on file. Preschool program utilizes two classrooms: Daisy Classroom (2- 5 years old), Sunflower Classroom (2-5 years old) and one Outdoor Play Area. Days and hours of operation are Monday- Friday 8:30am- 5:00pm. The montessori program operates year around. LPA inspected facility, indoors and outdoors, with licensee for health and safety hazards.

At 8:55 A.M., the following was observed: Classrooms inspected were clean, orderly with age-appropriate books and learning supplies available for the children. Facility floor and ground surfaces were free of any obstructions. Furniture and playthings inspected were proper repair. For storage, facility was equipped with individual cubbies for children's belongings. Each classroom had their own set of child size tables and chairs for planned activities. For napping services, foldable mats had been stored in each classroom. LPA reminded licensee to label the napping mats with each child’s name. Per licensee, children’s napping supplies are taken home to be washed by the families every weekly. The children’s bathrooms were reviewed during today’s inspection. Bathroom fixtures all were in proper operating condition, with adequate supplies available. Staff bathroom was located separately. Facility was the proper temperature, with sufficient ventilation and lighting. Cleaning detergents, supplies, spray bottles and all other toxins were made inaccessible. Accessible outlets had been properly covered. LPA reminded licensee to ensure all accessible trash bins remain covered. Facility had functioning telephone service, smoke detector, carbon monoxide detector and fully charged fire extinguishers (3A:40BC). First aid kits were reviewed during inspection.

At 9:15A.M., LPA inspected the outdoor play area. Outdoor space was completely enclosed with tall fencing and was free of trash or debris. Outdoor playthings inspected were in good repair. Area had proper shading accessible for children in care. Refillable water bottles are taken outside on rolling cart by staff. Per licensee, water containers are refilled from a non-contained source. Tanbark was placed around play structures to absorb any potential falls. (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: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022
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 4


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: BERESFORD MONTESSORI
FACILITY NUMBER: 414002467
VISIT DATE: 04/28/2022
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
26
27
28
29
30
31
32
(Page 2)

At 9:50A.M., LPA review the facility records including, Facility sign-in sheet, 10 children's files and 6 personnel files. Facility files reviewed included staff’s Criminal Record Statements (LIC508), Declaration to Report Suspected Child Abuse (LIC9108), Required Transcripts, Notice of Employee Rights (LIC9052) and Proof of immunization.

All classroom personnel have their current mandated reporter training certifications in the facility files.

Forms reviewed in children’s files included the children's Health History (LIC702), Identification of Emergency Information (LIC700), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995) and Immunization Records.

LPA reminded licensee to ensure children present are properly signed in. During inspection, Advisory Note: Technical Assistance (LIC9102) was issued.

On-site staff member has their current Cardiopulmonary resuscitation/ First Aid certification on file, expiring on 3/11/2024.

Facility is conducting emergency drills every six months, with the last drill done on, 3/24/2022, properly logged.

Per licensee, program provides daily snack services. Facility kitchen, refrigerator and food items were reviewed during inspection. Food items inspected were current and properly stored. Kitchen was made inaccessible.

Required posting were posted and included the: Childcare License, Notification of Parents Rights (PUB393), and Updated Emergency Disaster Plan (LIC610). LPA reminded licensee to post the lunch schedule and updated for families at least one week prior. (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: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BERESFORD MONTESSORI
FACILITY NUMBER: 414002467
VISIT DATE: 04/28/2022
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
26
27
28
29
30
31
32
(Page 3)

During inspection, LPA reviewed children’s medication and IMS plan on file. All medication inspected was current and in the original packaging.

Licensee 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.

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 observed in the areas evaluated, according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with the licensee, and signature of this form acknowledges receipt of these documents.



The 'Notice of Site Visit' 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: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4