414004507-1-7-2022-05-CC-ACON-CAG2Z6-20220107164950

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004507
Report Date: 01/07/2022
Date Signed: 01/07/2022 04:50:00 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:	LAKEVIEW MONTESSORI		FACILITY NUMBER:	414004507
ADMINISTRATOR:	BRAMHE,SHEILA		FACILITY TYPE:	840
ADDRESS:	31 VISTA AVENUE		TELEPHONE:	(650) 578-9532
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	30	CENSUS: 4	DATE:	01/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:21 PM
MET WITH:	Sheila Bramhe		TIME COMPLETED:	05:15 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 January 7, 2022, Licensing Program Analyst (LPA) Cowan met with the Site Director, for an unannounced annual inspection. The purpose of the inspection was explained. Present in the facility is director, 1 staff and 4 school ages children in care. The days and hours of operations are Monday – Friday, 12:30 PM - 6:00 PM. Facility operates from classroom #1 only. LPA, along with the Site Director, inspected the facility for health and safety hazards. A variety of age-appropriate toys and learning materials for children are available in the classroom. There are no pools, spas, or other bodies of water at the facility. Per Director, there are no firearms or weapons on the premises. The facility has a smoke detector, a carbon monoxide detector, fully charged fire extinguishers, and a working telephone. All cleaning solutions, poisons, and other dangerous chemicals stored are inaccessible to children. The facility is in good repair and free of any hazards with proper temperature and ventilation. The bathroom, toilets, and sinks are clean. At 1:00 PM, LPA observed that the facility does not have tightly fitted lids on trash cans. Facility has a water refill station readily available for children. The outdoor playground area is in good repair, and play structures are free of any loose parts. Report continues on next page

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022

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 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: LAKEVIEW MONTESSORI	FACILITY NUMBER: 414004507
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)(1)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/07/2022
	Plan of Correction
1 2 3 4	Director will have staff removed immediately and have staff member fingerprint cleared and associated before returning.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022

LIC809 (FAS) - (06/04)

Page: 2 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: LAKEVIEW MONTESSORI	FACILITY NUMBER: 414004507
	VISIT DATE: 01/07/2022

NARRATIVE

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At 1:39 PM, LPA reviewed 10 random samples of children's records. Files are complete with licensing documents.

At 2:49 PM, LPA reviewed 2 staff files. At 3:05, LPA observed that staff member did not have fingerprint clearance. This is an immediate risk to children in care. A type a citation will be issued this day.

LPA also observed that the facility had posted the required forms. (i.e., License, Notification of Parent's Rights, and Notification of Personal Rights). The Director stated that Fire and Earthquake drills are done each month.

LPA discussed Fingerprint clearance practices with director.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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.

Report continues on next page.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022

LIC809 (FAS) - (06/04)

Page: 4 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: LAKEVIEW MONTESSORI	FACILITY NUMBER: 414004507
	VISIT DATE: 01/07/2022

NARRATIVE

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Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

>See next page for deficiencies

Exit interview conducted and report was reviewed with the [or facility representative] (include name).

This report must be available in the facility for public review. Notice of site visit was observed being posted. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5