<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384000667
Report Date: 12/05/2022
Date Signed: 12/05/2022 01:37:16 PM

Document Has Been Signed on 12/05/2022 01:37 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 SCHOOL OF THE BAY AREA INC. - INFANTFACILITY NUMBER:
384000667
ADMINISTRATOR:DAVID THATHIAHFACILITY TYPE:
830
ADDRESS:1550 EDDY STREETTELEPHONE:
(415) 292-7970
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 13DATE:
12/05/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Vasi ThathiahTIME COMPLETED:
12:00 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 December 05, 2022, Licensing Program Analysts (LPAs) Ly and Olguin-Leon, arrived at the facility unannounced for a POC visit. LPAs met with Director Vasi Thathiah. Present during the visit were Director and 4 staff caring for 13 infants and toddlers.

During today's visit, LPAs was not able to clear citations cited on 11/15/ 2022 regarding staff CPR/First Aid, Staff Child's Abuse Mandated Reporter Training, Children's records on LIC9227 Infant Sleeping Plan and Infant's sleeping log.

Facility is cited for repeated violations. Type B deficiencies are being cited on this day in accordance with the California Code of Regulations, Title 22, see LIC 809D.

A copy of this report and appeal rights were discussed and left with Licensee whose signature on this form confirm receipt of reports. Notice of Site Visit was provided to licensee. Licensee was advised Notice of Site Visit to remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Winnie Ly
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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
Document Has Been Signed on 12/05/2022 01:37 PM - It Cannot Be Edited


Created By: Winnie Ly On 12/05/2022 at 11:29 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. - INFANT
FACILITY NUMBER: 384000667

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
Section Cited
HSC
1596.8662(b)(1

1
2
3
4
5
6
7
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
1
2
3
4
5
6
7
Staff will take the online course to renew.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above in all staff in infant program did not renew Child Abuse Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Director will email proof of completion to LPA by 01/16/2023.
Type B
01/16/2023
Section Cited
CCR101216(f)

1
2
3
4
5
6
7
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Staff will need to renew Pediatric CPR/First Aid.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above in staff in infant program did not renew Pediatric CPR/First Aid which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
 and email proof of completion to LPA by 01/16/2023.
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: 12/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 12/05/2022 01:37 PM - It Cannot Be Edited


Created By: Winnie Ly On 12/05/2022 at 11:35 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. - INFANT
FACILITY NUMBER: 384000667

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
Section Cited
CCR
101429(a)(2)(B)

1
2
3
4
5
6
7
(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Director will start having sleeping logs for infant in care and email proof of the log to LPA by 12/19/2022.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above in infants in care which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
12/19/2022
Section Cited
CCR101430(a)(3)(A)(4)

1
2
3
4
5
6
7
(A) Staff shall place infants up to 12-months of age on their backs for sleeping. (4) Infants with an Individual Infant Sleeping Plan [LIC 9227 (3/20)] that have Section C of the form completed and signed by an authorized representative shall be placed on their back when first laid down to sleep. In the event the infant changes position, the infant may remain in the alternative position.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Director will work with families to have LIC 9227 fill out email proof of completion to LPA by 12/19/2022.
8
9
10
11
12
13
14
Based on record review, the licensee did not comply with the section cited above in infants in care which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
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: 12/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022


LIC809 (FAS) - (06/04)
Page: 3 of 3