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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005417
Report Date: 04/30/2026
Date Signed: 04/30/2026 12:46:22 PM

Document Has Been Signed on 04/30/2026 12:46 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:HAMILTON MONTESSORI SCHOOLFACILITY NUMBER:
214005417
ADMINISTRATOR/
DIRECTOR:		ACKER, CINDYFACILITY TYPE:
850
ADDRESS:600 PALM DRIVETELEPHONE:
(415) 851-3299
CITY:NOVATOSTATE: CAZIP CODE:
94949
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 14DATE:
04/30/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Director, Cindy AckerTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On April 30, 2026, at approximately 10:40AM, Licensing Program Analyst (LPA) Nicole Tran conducted an unannounced case management visit and met with facility representative, Alyza Thornson. LPA disclosed the purpose of the visit and was granted entry into the facility by another facility representative, Carla Hamby. Director, Cindy Acker later joined the visit.

The Department has obtained information that there was an unusual incident on February 23, 2026. The incident involved a child leaving the facility through the courtyard gates unsupervised twice in one day. Based on information gathered, a staff member was able to quickly go after the child and bring them back to the facility both times in less than a minute. This incident is considered an unusual incident.

Per Director, on the day of the incident, they were supervising the children in the courtyard area with another teacher. Director states that the child did not leave the facility more than a few steps from the gate. Director states they and the other teacher had seen the child and were right behind them. LPA advised director of their appeal rights.

Child care centers are required to report all unusual incidents to the Department. Unusual incidents must be reported to the Department within 24 hours by telephone or fax. A written unusual incident report must also be submitted within 7 days of the incident.

The facility is being cited one Type “A” deficiency for not ensuring adequate supervision at all times leading to a child leaving the facility, and one Type “B” deficiency for not following reporting requirements.

Continued on Page Two
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: HAMILTON MONTESSORI SCHOOL
FACILITY NUMBER: 214005417
VISIT DATE: 04/30/2026
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Page Two

LPA Tran informed facility representative, Cindy Acker, that this report dated April 30, 2026, documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Tran informed facility representative to provide a copy of this licensing report dated April 30, 2026 that documents any Type A citation 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 and must remain posted for 30 days. Appeal rights were provided and explained.

Exit interview conducted and report was reviewed with facility representative, Cindy Acker.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Nicole Tran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/30/2026 12:46 PM - It Cannot Be Edited


Created By: Nicole Tran On 04/30/2026 at 10:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAMILTON MONTESSORI SCHOOL
FACILITY NUMBER: 214005417

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/01/2026
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)(1) “No child(ren) shall be left without the supervision of a teacher at any time...”

This requirement was not met as evidenced by:
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The center shall create a plan to ensure complete supervision for all children in care and train staff on it. The plan shall address solutions to prevent children from eloping from the facility as well. Documentation of the new supervision plan and staff training (with names/signatures of all staff present) will be submitted to LPA Tran by May 1, 2026.
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Based on interview and record review, the licensee did not ensure adequate supervision at all times. A child was able to leave the facility due to a lack of supervision. This posed an immediate health, safety, or personal rights 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.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Nicole Tran
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/30/2026 12:46 PM - It Cannot Be Edited


Created By: Nicole Tran On 04/30/2026 at 10:27 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HAMILTON MONTESSORI SCHOOL
FACILITY NUMBER: 214005417

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2026
Section Cited
CCR
101212(d)

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101212 Reporting Requirements (d) “Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report... shall be submitted to the Department within seven days following the occurrence of such event…"

This requirement was not met as evidenced by:
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The center must report to the Licensing Department any unusual incident or event that threatens a child's physical or emotional health or safety. The center/director agrees to ensure full compliance with reporting requirements. The center/director will review reporting procedures with all staff and implement a system to ensure that all incidents meeting reporting criteria are submitted to the Licensing Department within the required timeframe. Documentation of staff training (with names/signatures of all staff present) and updated reporting procedures will be submitted to LPA Tran by May 8, 2026.
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Based on interview and record review, the licensee did not ensure reporting requirements were met for unusual incidents. A child left the facility without teacher supervision, and the Department did not receive a report from the facility regarding the incident. This posed a potential health, safety, and 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.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Nicole Tran
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2026


LIC809 (FAS) - (06/04)
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