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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004587
Report Date: 11/20/2024
Date Signed: 11/20/2024 12:42:14 PM

Document Has Been Signed on 11/20/2024 12:42 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:MISSION MONTESSORI (PS)FACILITY NUMBER:
384004587
ADMINISTRATOR/
DIRECTOR:		DR.LARHONDA MARTINFACILITY TYPE:
850
ADDRESS:50 FELL STREETTELEPHONE:
(415) 805-8315
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY: 120TOTAL ENROLLED CHILDREN: 47CENSUS: 38DATE:
11/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Dr. LaRhonda MartinTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On November 20, 2024, Licensing Program Analyst (LPA) Zeynep Basak conducted a case management inspection and met with the executive director, Dr.LaRhonda Martin. The purpose of the inspection was explained to the director. Seven staff members and 38 children were present during the visit.

The case management was related to the unusual incident reports submitted by the director on 11/12/24.

The incident that occurred was when the teacher witnessed another teacher from an external agency grabbing the child by his wrist and bringing him to the group of children sitting down. The director stated the teacher was reported to the agency and terminated from working at the facility.

LPA discussed during the inspection to get more information on how the incident happened and what was done to prevent it from happening again. The facility will continue to take this matter seriously and staff will be reminded of Personal Rights.

A Type B violation will be cited on LIC 809D in accordance with Title 22 Division 12 Chapter 1 101223 Personal Rights (a)(3)

An exit interview was conducted with the director Dr.LaRhonda Martin.
The report and the Notice of Site Visit were provided to be posted for 30 days.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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 11/20/2024 12:42 PM - It Cannot Be Edited


Created By: Zeynep Basak On 11/20/2024 at 12:00 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: MISSION MONTESSORI (PS)
FACILITY NUMBER: 384004587

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2024
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement is not met by:
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The staff was terminated from working at the facility.
Staff member reminded of Personal Rights.
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Based on interviews, obtained information, and record review, the facility did not comply with the section cited above which poses a potential health, safety, or personal rights risk to 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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2024


LIC809 (FAS) - (06/04)
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