414004507-11-17-2022-05-CC-MROZ-CL9W47-20221117155703

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004507
Report Date: 11/17/2022
Date Signed: 11/17/2022 03:57:11 PM

Document Has Been Signed on 11/17/2022 03:57 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:	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:	15	CENSUS: 11	DATE:	11/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Fidaa Aslam		TIME COMPLETED:	04:15 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	Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced annual inspection. LPAs met with Teacher Fidaa Aslam and explained purpose of the inspection. Facility runs a school aged after school program in classroom 1 and a preschool program with a toddler option under license #414004506. Present in the program were one teacher and six school aged children. Five more children arrived a short time later. Center is operating within capacity limits and in compliance with staff to child ratio. Hours of operation are Monday to Friday from 8:30am to 5:30pm. LPA inspected indoor and outdoor areas of school with Teacher. There are no bodies of water, firearms, or weapons on the premises. Classroom is in good condition with proper temperature and ventilation and are free of any hazards. Furniture in classroom is in good repair. Classroom has age appropriate toys and equipment. Classroom has a bathroom with two sinks, one enclosed toilet, and one urinal. Bathroom appears to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage. 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 in the front entrance of the facility. Menu is posted for the month. Facility provides lunch and morning and afternoon snacks. 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. Last emergency drill was conducted in November 2022. Emergency drills are conducted every month and are properly logged. Paper sign-in/out sheets are located inside a binder at the entrance of the school. The center has a complete paper record of sign-in/out sheets by authorized pickup person. There is a working fire alarm and sprinkler system throughout the center. A carbon monoxide detector and a fully charged fire extinguisher is in each classroom and a working telephone is available on-site.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

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: LAKEVIEW MONTESSORI	FACILITY NUMBER: 414004507
	VISIT DATE: 11/17/2022

NARRATIVE

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Six children records reviewed were complete. All children have a record of emergency identification information on file. One staff record reviewed was complete. All staff have a criminal record clearance on file. Appointed staff have current pediatric first aid/CPR certificate on file.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Facility representative was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until translation is available.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (US DOJ) 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility representative 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.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 11/17/2022

NARRATIVE

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LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Facility Representative Fidaa Aslam.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC809 (FAS) - (06/04)

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