214005482-4-5-2024-05-CC-HLEG-D42VKS-20240405163050

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005482
Report Date: 04/05/2024
Date Signed: 04/05/2024 04:32:41 PM

Document Has Been Signed on 04/05/2024 04:32 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	ACQUA MONTESSORI SCHOOL		FACILITY NUMBER:	214005482
ADMINISTRATOR/ DIRECTOR:	NICOLAS RYAN MENDOZA		FACILITY TYPE:	850
ADDRESS:	8 N SAN PEDRO RD		TELEPHONE:	(415) 755-7075
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 13	DATE:	04/05/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:37 PM
MET WITH:	Nico Mendoza		TIME VISIT/ INSPECTION COMPLETED:	04:35 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 4/5/2024, Licensing Program Analyst (LPA) Hanson Leong conducted an unannounced annual visit to the Child Care Center (CCC) listed above. LPA met with the Director, Nico Mendoza, and explained the purpose of the visit. Thirteen preschool-aged children and four staff members were present during the visit. The four staff members present at the CCC have all received criminal record clearance from the department. The CCC operates within its capacity and in accordance with the required ratio of staff to children.

LPA observed that all required documents, such as the facility license, waivers, notification of parental rights, notification of personal rights, car seat law, emergency disaster plan, and daily activities, were displayed in the CCC. LPA observed that the last emergency disaster drill was conducted on 10/17/2023 and properly recorded.

According to the director, the children are responsible for bringing their own lunch to the CCC, as the CCC only provides morning snacks. LPA observed that snacks were available at the CCC, and the children brought their own lunch boxes and water bottles.

LPA observed that the CCC maintains a paper record of the children’s attendance, with corresponding parental signatures, and all enrolled children are accounted for during the day.

LPA and the director conducted an inspection to identify potential health and safety hazards. LPA observed that the inside of the CCC was clean, safe, sanitary, and in good repair. The CCC is equipped with a fully stocked first aid kit, functioning smoke and carbon monoxide detectors, and a fully charged fire extinguisher.

LPA observed that the classrooms were equipped with age-appropriate toys, furniture, and educational materials. LPA observed that each child has an individual permanent or portable storage space for his/her clothing and personal belongings at the CCC.
See Page 2

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ACQUA MONTESSORI SCHOOL	FACILITY NUMBER: 214005482
	VISIT DATE: 04/05/2024

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
26
27
28
29
30
31
32

Page 2
LPA observed bathrooms to be clean and in working condition. Bathroom garbage bins were observed to have tight-fitting lids. The sink was observed to be in working condition and not providing water warmer than 120 degrees Fahrenheit. LPA observed that the toilets and handwashing facilities at the CCC were in safe and sanitary operating condition.

LPA observed that all accessible classroom cabinets and drawers did not contain hazardous materials or poisons. LPA observed that poisons, cleaning solutions, and chemicals were stored on high shelves or shelves with child safety locks to make them inaccessible to children.

LPA observed that a fence enclosed the outdoor playground, and the equipment and furniture were in good condition. The areas around and under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs falls. LPA observed that the CCC did not have any pools, spas, or other types of bodies of water in the outdoor area.

LPA observed that the CCC has a specific sleeping/resting area for children. LPA observed that the CCC is equipped with cots and blankets.

LPA reviewed five children’s files and confirmed that all five children have complete files that include their emergency contact and medical information.

LPA reviewed the files of four staff members and found that one was current with their Pediatric First Aid/CPR certifications. After reviewing the transcripts of all four staff members, LPA discovered that two completed their twelve required Early Childhood Education units to become qualified teachers.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was not completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
See Page 3

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ACQUA MONTESSORI SCHOOL	FACILITY NUMBER: 214005482
	VISIT DATE: 04/05/2024

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
26
27
28
29
30
31
32

Page 3
A deficiency was cited for failing to complete lead water testing for CCC before 1/1/2023, during a previous visit on 2/29/2024.

Director was reminded that all adults 18 and over, 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.

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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers

Director was informed of the MyChildCarePlan.org website; 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

No deficiencies were issued today during LPA's visit.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Nico Mendoza.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Hanson Leong
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3