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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380506275
Report Date: 10/08/2024
Date Signed: 10/08/2024 03:44:34 PM

Document Has Been Signed on 10/08/2024 03:44 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:MARIA MONTESSORI SCHOOL OF THE GOLDEN GATEFACILITY NUMBER:
380506275
ADMINISTRATOR/
DIRECTOR:		ALAVI, TARANEHFACILITY TYPE:
850
ADDRESS:62 LENOX WAYTELEPHONE:
(415) 731-8188
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
10/08/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Director, Taraneh AlaviTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
NARRATIVE
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On 10/8/2024, at approximately 3:00PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced POC visit at the facility. LPA met with Director Taraneh Alavi (D1) and explained the purpose of the visit. Present during the visit was D1, two staff, and 15 preschool age children.

On 7/17/2024, LPA conducted an unannounced annual visit at the facility and observed that there was a staff member present without fingerprint clearance at the facility. LPA informed D1 that a Type A deficiency would be cited during the visit, and that the report must be made available to all parents to review. Director was informed that an Acknowledgment of Receipt of Licensing Forms (LIC9224) must be signed by all parents and placed in each current and newly enrolled child's file for the next year (until 7/17/2025).

On 9/13/2024, LPA reviewed three children's files and did not observe any signed LIC9224 forms to be present. LPA discussed the requirement to provide parents and authorized representatives a copy of the report dated 7/17/2024 in addition to an LIC9224 with D1. D1 stated that they understood. LPA informed D1 that a Type B deficiency would be cited during the visit. LPA and D1 discussed a plan of correction and agreed upon a due date of 9/27/2024. A copy of LIC9224 was printed and provided to D1 during the visit.

Based on record review of three children’s files during today’s visit, LPA observed LIC9224 to be present in all children's files. Deficiency cited on 9/13/2024 shall be cleared as of today, 10/8/2024.

Based on record review of the facility files, LPA found that an unusual incident that posed a risk to the physical or emotional health or safety of a child was not reported to the Regional Office by telephone within 24 hours of the incident or by written report within seven days of the incident. LPA discussed reporting requirements with D1 during the visit. LPA informed D1 that a Type B deficiency would be cited during today’s visit. A plan of correction was discussed and agreed upon. This deficiency shall be cited and cleared the same day of the visit, 10/8/2024.

See LIC809-D for deficiency cited and cleared today regarding reporting requirements. Appeal rights were provided and explained. A notice of site visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director, Taraneh Alavi.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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 10/08/2024 03:44 PM - It Cannot Be Edited


Created By: Jonathan Tse On 10/08/2024 at 03:00 PM
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: MARIA MONTESSORI SCHOOL OF THE GOLDEN GATE
FACILITY NUMBER: 380506275

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/15/2024
Section Cited
CCR
101212(d)

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(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 containing the information specified in (d)(2) below 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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Reporting requirements were discussed with D1 during today's visit. D1 stated that they understood reporting requirements and would comply if future incidents occurred.
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Based on record review, the Licensee did not comply with the above by not notifying the Regional Office of an unusual incident that threatened the physical or emotional health or safety of any child. This posed a potential risk to the health and safety of 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.
SUPERVISOR'S NAME:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


LIC809 (FAS) - (06/04)
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