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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380503970
Report Date: 09/15/2022
Date Signed: 09/15/2022 01:19:44 PM

Document Has Been Signed on 09/15/2022 01:19 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MONTESSORI CHILDREN'S HOUSE OF THE WEST COASTFACILITY NUMBER:
380503970
ADMINISTRATOR:ELLIOTT, GRACEFACILITY TYPE:
850
ADDRESS:25 LAKE STREETTELEPHONE:
(415) 221-4624
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94118
CAPACITY: 60TOTAL ENROLLED CHILDREN: 42CENSUS: 42DATE:
09/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Brianne Huang TIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced case management inspection for the Action Level Exceedance(ALE) of Lead in a Child Care Center's water. LPA met with the Interim Site Director, Brianne Huang. The purpose of the inspection was explained to her. There were 42 children with 9 staff present
LPA discussed the new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires the Lead Testing of water in the Child Care Center with the site director during the inspection. All Child Care Centers that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing,

Due to the results, CCL received a higher level of parts per billion(ppb) allowed, LPA inspected the facility for health and safety hazards. The facility was proactive in getting facility faucets tested. The facility received the ALE report from the Vendor on 7/1/2022. The facility took quick action to close the faucet in the kitchen. The licensee replaced a new faucet that will be retested by the Terra Phase Engineering on 9/16/2022 . The facility provides distill water to the children recently.


LPA obtained a copy of the test result from California Rural Water Association during the inspection. The facility submitted the Sampling Documents for the Lead Water Test to CCL on 6/23/22.



* See next page for deficiency cited today
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Cindy Mok
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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Document Has Been Signed on 09/15/2022 01:19 PM - It Cannot Be Edited


Created By: Cindy Mok On 09/15/2022 at 11:51 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: MONTESSORI CHILDREN'S HOUSE OF THE WEST COAST
FACILITY NUMBER: 380503970

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
101238

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101238 Buildings and Grounds
The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by
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The facility closed the faucet in the kitchen now. The facility replaced a new faucet that will be retested by Terra Phase Engineering on 9/16/22. The facility provides distill water to the daycare children recently.
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Based on the results of the lead testing of water, the facility did not ensure to maintain a level to be under 5 ppb at the faucet in the kitchen. It poses potential health, safety, and personal Rights risk to persons in care.
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The facility will provide a result after the water is retested by 9/30/22.

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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.
SUPERVISOR'S NAME:Garfield Leung
LICENSING EVALUATOR NAME:Cindy Mok
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022


LIC809 (FAS) - (06/04)
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