013420938-5-4-2023-52-CC-AWRT-CRHW26-20230504165350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420938
Report Date: 05/04/2023
Date Signed: 05/04/2023 04:54:00 PM

Document Has Been Signed on 05/04/2023 04:54 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	EMPIRE MONTESSORI PRESCHOOL		FACILITY NUMBER:	013420938
ADMINISTRATOR:	SHIMEI YANG		FACILITY TYPE:	850
ADDRESS:	3765 WASHINGTON BLVD		TELEPHONE:	(510) 979-1696
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 51	DATE:	05/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:23 PM
MET WITH:	July Grace Galaraga		TIME COMPLETED:	05:00 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 May 4th, 2023 at approximately 2:05pm, Licensing Program Analyst (LPA) April Wright arrived for an unannounced Required-1 Year inspection, and met with director July Grace Galaraga. Present today were 51 preschool children and five (5) fingerprint cleared staff members present during the inspection. The facility is in ratio today. The facility was toured for a health and safety inspection. Hours of operation are Monday through Friday, 8:00am to 6:00pm. CLASSROOMS: Four (4) classrooms were inspected and have adequate play and learning materials available. Classroom 4 is used for storage only, not in use since the pandemic and is inaccessible to children. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting for safety and comfort. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is in the director office, away from other children in care. The center has fully operational smoke/carbon monoxide detectors, working telephone, and four (4) fully charged 3A40BC fire extinguishers per each classroom. The center is equipped with fully stocked first aid kits that is available in all classrooms. BATHROOMS AND TOILETING AREAS: The staff's bathroom is separate from the children's bathroom. Located in lobby area of facility. All children's bathroom sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets. Supplies are available to the children. FOOD SERVICE AREAS: This facility provides am snack, lunch and pm snack daily for children in care. There are monthly menus posted at the facility. All storage containers for solid waste have tight fitting covers that are in good repair. Facility has a refrigerator which is clean and free of evidence of rodents, vermin or insects. See LIC809-C for continuance

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: EMPIRE MONTESSORI PRESCHOOL	FACILITY NUMBER: 013420938
	VISIT DATE: 05/04/2023

NARRATIVE

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OUTDOOR PLAY AREAS: There's one (1) large play structure with a three (3) slides and small structure with tunnel that has foam cushioning to absorb falls that is anchored for stability. There is a canopy area with artificial grass that provides shade to children while at play. Facility also age appropriate toys that are in good condition.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Six (6) children's files and six (6) staff files were reviewed including the directors file. All staff files have required health screening and Employee Rights and all children files contain Identification & Emergency, Personal Rights, and Medical Consent forms. LPA reviewed the staff and children's roster and obtained a copy. Mandated Reporter Training certificates and CPR and First Aid certificates are current and up to date for all staff members staff. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted monthly and the last one conducted was on 4/3/2023. All required documents are posted in a public accessible area.

Incidental Medical Services (IMS) policy was discussed. IMS IS PROVIDED AT THIS FACILITY. LPA reviewed storage of medication (director's office in white medicine locker) and equipment/supplies, and reviewed children’s, personnel, and administrative records for accuracy. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

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.

See LIC809C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: EMPIRE MONTESSORI PRESCHOOL	FACILITY NUMBER: 013420938
	VISIT DATE: 05/04/2023

NARRATIVE

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California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. All forms can be downloaded at www.ccld.ca.gov

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/inspection-process .

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Center Director July Grace Galaraga

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

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