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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412158
Report Date: 11/21/2022
Date Signed: 12/09/2022 03:40:54 PM


Document Has Been Signed on 12/09/2022 03:40 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:PALO ALTO PRESCHOOL BILINGUAL MONTESSORIFACILITY NUMBER:
434412158
ADMINISTRATOR:PULDA, VIRGINIAFACILITY TYPE:
850
ADDRESS:4232 EL CAMINO REALTELEPHONE:
(650) 739-0137
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:118CENSUS: 62DATE:
11/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:29 PM
MET WITH:Weija CaiTIME COMPLETED:
06:35 PM
NARRATIVE
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On 11/21/2022 at 1:29pm Licensing Program Analyst (LPA) Morgan Pringle met with facility staff Weija Cai for an Unnounced 10-Day complaint investigation. A complaint was was received alleging children's personal rights were violated. During LPA's inspection there were sixty-two (62) preschool children and eight (8) staff members. During LPA's inspection interviews were conducted and a tour of the facility was taken. LPA obtained the facility roster and personnel roster and obtained a sample of the staff files.

Through record review it was found that one (1) staff member present at the facility did not have an associated criminal record clearance (See LIC809D). Through record review it was also found that three (3) staff members present at the facility did not have a criminal record clearance (See LIC809D). It was also found that none of the staff on site held a Pediatric CPR & First Aid certificate (See LIC809D).

Type A Deficiency cited during inspection on 11/21/2022
· Three (3) staff members missing criminal record clearances

Type B Deficiencies citied during inspection on 11/21/2022:
· One (1) staff member missing associated criminal record clearance
· No staff on site have a Pediatric CPR & First Aid training certificate

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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PALO ALTO PRESCHOOL BILINGUAL MONTESSORI
FACILITY NUMBER: 434412158
VISIT DATE: 11/21/2022
NARRATIVE
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LPA Pringle informed facility representative Weija Cai that this report dated 11/21/2022 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Pringle informed the facility staff to provide a copy of this licensing report dated 11/21/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


A notice of site visit was given to licensee and must be posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Weija Cai

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 12/09/2022 03:40 PM - It Cannot Be Edited

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: PALO ALTO PRESCHOOL BILINGUAL MONTESSORI
FACILITY NUMBER: 434412158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/28/2022
Section Cited

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(i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations or...
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This requirement was not met as evidenced by: There were one (1) staff on site did not have a cleared criminal record clearance transfer association. This poses a immediate safety & health risk to the children 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) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 12/09/2022 03:40 PM - It Cannot Be Edited

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: PALO ALTO PRESCHOOL BILINGUAL MONTESSORI
FACILITY NUMBER: 434412158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2022
Section Cited

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101216(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.
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This requirement was not met as evidenced by: None of the staff members on site have a certification in Pediatric CPR & First Aid. This poses a potential safety & health risk to children in care.
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Type B
11/28/2022
Section Cited

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(i) Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or...
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This requirement was not met as evidenced by: There were one (1) staff on site did not have a cleared criminal record clearance transfer association. This poses a potential safety & health risk to children 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) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4