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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407486
Report Date: 03/23/2022
Date Signed: 03/23/2022 04:16:30 PM

Document Has Been Signed on 03/23/2022 04:16 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ALICE'S MONTESSORI LEARNING CENTERSFACILITY NUMBER:
073407486
ADMINISTRATOR:SAMANTHA SHUMANFACILITY TYPE:
830
ADDRESS:1041 HOOK AVE.TELEPHONE:
(925) 947-0600
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
03/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Samantha ShumanTIME COMPLETED:
04:30 PM
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On 3/23/22 at 1:30 pm Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts conducted an unannounced Annual inspection at Alice's Montessori Learning Centers - Infant program. LPA met with Director, Samantha Shuman and explained the purpose of today's inspection. Facility's operating days and hours are Monday to Friday 7:45 am - 5:45 pm in 1 large room which is separated into infants and toddler sections. Present during inspection were 15 infants and 5 staff (Director, 2 fully qualified 3 Aides). They are in compliance with ratio requirement during inspection. Infants were engaged in various activities under the visual supervision of the teachers.
Indoor Space: physical plant was inspected and toured with the Director.
Room, diaper changing area, restroom were inspected. Food and feeding bottles were labeled and stored safely. Food storage areas were sanitary, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. Napping area had cribs and was cordoned off from the activity area by dividers. The infant changing table has raised sides that are at least 3 inches in height, has a vinyl changing pad that is at least 1 inch thick and in good condition. Napping equipment is appropriate. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Floors were clean and free from tripping hazard. LPA observed a working fire extinguisher, smoke and carbon monoxide detectors.
Outdoor Space: Outdoor activity space was inspected and observed to be safe. The play equipment is age appropriate and maintained in good condition and free of hazards. There were no bodies of water observed.
File Review: Sign in and out procedures and logs were reviewed. A sampling of child and staff files was taken for review. LPA reviewed the Needs and Services Plan for all infants which were updated quarterly. LPA provided information and technical assistance on Safe Sleep Plan LIC9227 for infants under age 1 and Sleep Log for all infants. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. A copy of Children Roster was obtained.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ALICE'S MONTESSORI LEARNING CENTERS
FACILITY NUMBER: 073407486
VISIT DATE: 03/23/2022
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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
Director 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.
LPA discussed the safe sleep regulations with Director 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 Director 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.

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.

In the areas that were evaluated, no regulatory violations were observed. Interview conducted and report was reviewed with the Director, Samantha Shuman, A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
LIC809 (FAS) - (06/04)
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