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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400139
Report Date: 06/18/2021
Date Signed: 06/18/2021 03:54:04 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HOBBLEDEHOY MONTESSORI PRESCHOOLFACILITY NUMBER:
434400139
ADMINISTRATOR:ALKHATTAT, ZOITSAFACILITY TYPE:
850
ADDRESS:2321 JANE LANETELEPHONE:
(650) 968-1155
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94043
CAPACITY:42CENSUS: 15DATE:
06/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Zoitsa AlkhattatTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) James Sampair conducted an unannounced random annual site inspection of this facility at 9:30AM. LPA toured the facility with Administrator Zoitsa Alkhattat through all areas of the facility inside and outside. Also present were 2 additional teaching staff (1 Director-Level Qualified and 1 Teacher Aide) who cared for the 15 children. The facility was within capacity, as was the Teacher-Child Ratio. All of the children were supervised and all of the staff present were background cleared and associated with this facility.

The furnishings and equipment are age-appropriate. Counters and surfaces, including floors, are free of toxins. There are no hazardous items/toxins observed to be accessible to children in care. The children bring their own lunches and the facility provides them with snacks. The food preparation areas and refrigerators were clean and organized. The outdoor play areas are fully fenced with age-appropriate climbing equipment and slides in the play area that are securely anchored with cushioning under and around the structures. There are no pools or other bodies of water accessible to children. There is a fully charged fire extinguisher and the facility has centralized fire alarm system and individual carbon monoxide modules. Per Ms. Alkhattat, there are no firearms present or stored on the premises.

The roster was out of date by more than a year (last updated as of 03/19/2019). Three (3) children's files were reviewed and #1 was not complete. Three (3) staff records were reviewed and #2 and #3 were not complete. #2 had an incomplete Health Screening Report and a Mandated Reporter Training that expired 4/18/20. More than one staff member present has current CPR/First Aid certification. All required postings were present.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HOBBLEDEHOY MONTESSORI PRESCHOOL
FACILITY NUMBER: 434400139
VISIT DATE: 06/18/2021
NARRATIVE
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This facility provides Individual Medical Services (IMS). LPA reviewed storage of medication, equipment, and supplies, and they were found to be handled in accordance with regulations. For IMS information, see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information was provided: US Department of Justice (USDOJ) toll-free Americans with Disabilities Act (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.

Facility Staff are encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. Staff are also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. Facility administrator was provided with CDSS Effects of Lead Exposure Informational and lead testing requirements were discussed.

Three (3) Type B deficiencies were cited today for violation of Health and Safety Code sections1596.8662(b)(1) and 1596.841; and violation of Title 22 of the California Code of Regulations section 101216(g)(2)(B). Exit interview was conducted with the Licensee at 3:50PM. All applicable documents were provided to Licensee, including LIC809. The appeals rights and a notice of site visit were provided that is to be posted for 30 days. A copy of this report was provided. It is to be kept in the facility records for a period of three (3) years.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HOBBLEDEHOY MONTESSORI PRESCHOOL
FACILITY NUMBER: 434400139
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2021
Section Cited

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1596.8662 training for mandated reporter ... employee of a licensed child day care facility ... proof of completion (b)(1) renewal mandated reporter training every two years. This requirement was not met as evidenced by:
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Based on a review of the records the Licensee did not ensure that employee's mandated reporter training had been renewed, which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Type B
06/25/2021
Section Cited

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101216 Personnel Requirements (g) All personnel ... (2) shall have a health-screening report signed by the person performing the screening. (B) The presence of any health condition that would create a hazard to the person, children or other staff members.
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Based on a review of the records, the Licensee did not ensure that employee's Health Screening Report was completed, which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2021
LIC809 (FAS) - (06/04)
Page: 3 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HOBBLEDEHOY MONTESSORI PRESCHOOL
FACILITY NUMBER: 434400139
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2021
Section Cited

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1596.841 Each child day care facility shall maintain a current roster of children who are provided care in the facility.... This roster shall be available to the licensing agency upon request. This requirement was not met as evidenced by:
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The roster was out of date by more than a year (last updated as of 03/19/2019).
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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: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4