013423772-12-17-2024-02-CC-MDOY-DC2T4Q-20241217132418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423772
Report Date: 12/17/2024
Date Signed: 12/17/2024 01:24:39 PM

Document Has Been Signed on 12/17/2024 01:24 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	GRAND LAKE MONTESSORI		FACILITY NUMBER:	013423772
ADMINISTRATOR/ DIRECTOR:	ALICIA COOPER		FACILITY TYPE:	860
ADDRESS:	466 CHETWOOD STREET		TELEPHONE:	(510) 836-4313
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94610
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 97	DATE:	12/17/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Alicia Cooper		TIME VISIT/ INSPECTION COMPLETED:	01:45 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 December 17, 2024, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) M. Domantay met with Director Alicia Cooper for the purpose of a pre-licensing inspection. Applicant is requesting for a new infant program ages 6 weeks months to 18 months (capacity 24) and decreasing the existing preschool program ages two years to first grade entry to (capacity 143) and toddler program (capacity 28) remains the same. Facility is requesting to be licensed to serve a total of 195 children. The program will operate Monday through Friday from 8:00 a.m. to 6:00 p.m. Facility does not offer food for the infant program. All infant food will be provided from home by families. Facility does offer food for the toddler and preschool programs, but food is also provided by families from home if they are not signed up for the food program. LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA informed Alicia, that the facility will be converted to a single child care center license under facility number 013423772, therefore LPA will be closing the current preschool facility number 010210354. The fire clearance was granted and received on 8/29/2024 from the Oakland Fire Department for 24 infants, ages 6 weeks-18 months, 28 toddlers, ages 18-36 months, and 143 preschoolers, ages 2 years to first grade entry. INDOOR ACTIVITY SPACE: There are 3 indoor areas for the infant program, Infant Room 1 (Willow) and Room 2 (Sage) and a designated crib room. LPA observed a sufficient amount of equipment, furniture, and toys. Facility plans to care for 11 crib aged infants. LPA observed 11 cribs on site. LPA observed changing tables are in hands reach of a sink in the infant classroom. Medications will be stored in a locked cabinet in the infant classroom and in a locked box in the office refrigerator (inside and on the top). LPA observed a first aid kit in the infant classroom. Page 1

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GRAND LAKE MONTESSORI	FACILITY NUMBER: 013423772
	VISIT DATE: 12/17/2024

NARRATIVE

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LPA measured indoor infant classrooms. The total classroom space for the infant classroom contains a total of 970.01 square feet, which will accommodate Applicant's request for 24 infant children.

LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPA observed a functional carbon monoxide detector in the infant room 1 (Willow) on the wall by the counter/sink. There is a kitchen present by infant room 2 (Sage) and there is a children's gate to ensure the kitchen area is inaccessible to children. LPA observed a electronic sign-in/sign-out system.

There is 2 toilets and 3 sinks available for infant children in Infant room 1 (Willow), and a separate private restroom for the staff is located within the facility. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the child's rest area in the main office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
LPA measured the outdoor infant program area. There is 1 infant play yard. The outdoor play area is fenced with wooden fencing that is at least four feet tall and surrounded by facility building. There is turf to cushion a child's fall. Per Alicia, they are planning to install real grass and moss in the open areas where turf is not present and will send photos to LPA once completed. LPA observed there were age appropriate equipment and toys in the infant play yard. LPA notified Alicia additional equipment and toys are needed in the play yard and to send a photo to LPA. There is no play structure present in the infant outdoor play yard area. There are no bodies of water on the premises. There is sufficient shading provided by canopies and trees. LPA notified Alicia that water tables must be fully emptied after every use.

The total outdoor space for the infant play yard contains a total of 1516.55 square feet, which will not accommodate Applicant's request for 24 infant children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

LPA notified Director, Alicia Cooper, Applicant will need to submit a request for a waiver for the outdoor infant play area to accommodate the maximum capacity of 20 infant children outdoors at any given time with a set schedule in place.
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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GRAND LAKE MONTESSORI	FACILITY NUMBER: 013423772
	VISIT DATE: 12/17/2024

NARRATIVE

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INDOOR ACTIVITY SPACE:
There are 4 indoor areas for the preschool program, Classrooms: Live Oak, Juniper, Sycamore, and Pear. All preschool measurements for the classrooms listed remain the same from previous inspections. LPA observed a sufficient amount of equipment, furniture, cots, and toys.

There are 2 indoor toddler areas, Classrooms: Mulberry and Camellia. All measurements remain the same for the toddler program from previous inspections. No changes to toddlers indoor, outdoor, or capacity.

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Administrator any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Administrator was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Administrator was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GRAND LAKE MONTESSORI	FACILITY NUMBER: 013423772
	VISIT DATE: 12/17/2024

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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) or (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 Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Director, Alicia Cooper.

The following items are required before a license will be issued:

1. Licensing Program Manager (LPM) final file review.

2. Applicant must submit photos of infant play yard once grass and moss is installed.

3. Applicant will need to submit a request for a waiver for the outdoor infant play area to accommodate the maximum capacity of 20 infant children outdoors at any given time with a set schedule in place.

4. Applicant must submit photos of additional equipment and toys in infant outdoor play yard.

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

LIC809 (FAS) - (06/04)

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