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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505730
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:04:52 PM

Document Has Been Signed on 01/24/2024 12:04 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:MONTESSORI SCHOOL OF THE BAY AREA, INC.FACILITY NUMBER:
380505730
ADMINISTRATOR:VASI THATHIAHFACILITY TYPE:
850
ADDRESS:1550 EDDY STREETTELEPHONE:
(415) 292-7970
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 5DATE:
01/24/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Vasi ThathiahTIME COMPLETED:
12:15 PM
NARRATIVE
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On January 24, 2024 at approximately 11:05am, Licensing Program Analysts (LPAs) Ly and Nasiripour conducted an unannounced, case management inspection for the Action Level Exceedance (ALE) of Lead in Child Care Center's water. LPA met with the Site Director, Vasi Thathiah. The purpose of the inspection was explained.

Facility is a combination center that includes a preschool and the toddler component. Present during today's visit are 5 preschool and 7 toddlers with 4 staff members including the Director .

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.

Lead Test result for this facility that exceeded a higher level of parts per billion (ppb) allowed, 5.5ppb was uploaded on the State Water Board on 12/19/2023. The facility's faucet labeled as A30 has the result of 36ppb. The facility was proactive by putting signs indicating that the water faucet is not for drinking and is currently out of order.

On this day, facility submitted Lead Testing Results, Self-Certification Form (LIC9275), Child Care Center Sampling Checklist (LIC9276), Facility Sketch (LIC999) to the department via email.

* See next page for deficiency cited today.

A copy of this report was discussed and left with Director whose signature on this form confirm receipt of these reports. Notice of Site Visit was posted. Notice to remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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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Document Has Been Signed on 01/24/2024 12:04 PM - It Cannot Be Edited


Created By: Winnie Ly On 01/24/2024 at 11:31 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 SCHOOL OF THE BAY AREA, INC.
FACILITY NUMBER: 380505730

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2024
Section Cited

101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement was not met as evidenced by:
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The facility has put up signs at affected faucet indicating that the water faucet is not for drinking and is currently out of order.
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Based on observation, interview and record review, the facility did not ensure to maintain a level to be under 5 ppb at water fountains in classrooms. This poses a potential health, safety or personal rights risk to persons in care.
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Facility must have running water for A30 Facucet until faucet is retested with a certified water sampler by 02/26/2024.

Once retest is done, faciity representative will submit retest result to the department.

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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:Winnie Ly
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024


LIC809 (FAS) - (06/04)
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