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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004114
Report Date: 02/11/2025
Date Signed: 02/11/2025 10:43:01 AM

Document Has Been Signed on 02/11/2025 10:43 AM - 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:STUDIO MONTESSORI, LLC (PS)FACILITY NUMBER:
384004114
ADMINISTRATOR/
DIRECTOR:		DOMINGO, ROCHELLEFACILITY TYPE:
850
ADDRESS:633 8TH STREETTELEPHONE:
(415) 510-1287
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94103
CAPACITY: 31TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
02/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:29 AM
MET WITH:Zoe PaulTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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C1 = Child 1

On February 11, 2025 at approximately 8:40 AM, Licensing Program Analyst (LPA) Tso conducted an unannounced, case management visit. LPA met with Licensee, Zoe Paul, and explained the purpose of the visit. Present in the facility is licensee, director, 2 staff, and 12 children in care.

The case management visit is regarding an unusual incident that occurred on February 3, 2025. Facility self-reported incident to CCLD on February 4, 2025.

On February 3, 2025, at approximately 4.50pm, 3 Police Officers arrived the facility with a child (C1) and returned C1 to the facility. C1 had been left at the courtyard about 30 minutes. A resident of the apartment building found C1 and called the Police. This posed a potential risk to the health, safety or personal rights risks to the person in care. A Type B citation is issued for this deficiency this day. (See LIC809 D)

An exit interview was conducted with the Licensee, Zoe Paul, and a plan of correction was discussed. A copy of this report with the appeal rights was discussed and provided, and the signature of this form acknowledges the receipt of these documents. A notice of site visit was given to the Licensee and must remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Man Tso
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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 02/11/2025 10:43 AM - It Cannot Be Edited


Created By: Man Tso On 02/11/2025 at 10:10 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: STUDIO MONTESSORI, LLC (PS)
FACILITY NUMBER: 384004114

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee / Director shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement was not met as evidenced by:
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Licensee agreeed to train the staff on proper supervision and email LPA agenda and a signature of all in attendance by 02/25/25.

The Licensee conducted the proper supervsion training, including the off campus safety on 2/7/2025 with the signatures of all in attendance.
The deficiency was cleared on today (2/11/2025)visit.
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Based on interview, Incident report, and inforamtion obtained, staff left a child alone without supervision in the courtyard for approximately 30 minutes, which poses/posed a potential risk to health, safety or personal rights risk to persons 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:Garfield Leung
LICENSING EVALUATOR NAME:Man Tso
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


LIC809 (FAS) - (06/04)
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