384004643-1-17-2023-05-CC-SLOO-CN6TXG-20230117140706

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004643
Report Date: 01/17/2023
Date Signed: 01/17/2023 02:07:47 PM

Document Has Been Signed on 01/17/2023 02:07 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:	POTRERO HILL MONTESSORI SCHOOL		FACILITY NUMBER:	384004643
ADMINISTRATOR:	YANG, LIU		FACILITY TYPE:	850
ADDRESS:	1701 17TH STREET		TELEPHONE:	(650) 476-3015
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94103
CAPACITY:	54	CENSUS: 0	DATE:	01/17/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:06 AM
MET WITH:	Liu Yang		TIME COMPLETED:	02:07 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 January 17, 2023, Licensing Program Analyst (LPA) Sheran Lo met with Applicant Liu Yang today for a pre-licensing inspection. The applicant is requesting 30 children (ages 2 years to entry into first grade) and 24 toddlers (ages 18 months to 36 months). The facility will operate Monday - Friday; 7:00 AM to 6:00 PM. The designated director/site supervisor for the facility is also applicant. The facility was inspected today indoor for health and safety hazards and measured to calculate capacity. Indoor: There are three classrooms that will be used for the program and the following square footage was calculated for each room: Room 1: 1,056 sq ft., Room 2: 430.5 sq ft, and Room 3: 453. Total useable indoor square footage is 1,939.5 sq ft divided by 35 sq ft equals 55 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There is storage space for children's personal belongings and cribs to be utilized for napping children. Facility will provide a sheet and blanket for children and bedding will be laundered on site. Cribs will be cleaned daily or more often if needed. Children will be signed in and out with a tablet to be kept in classrooms. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, separate kitchen area where snack food is stored, garbage cans with tight-fitting lids, first aid and emergency supplies. The facility is adequately ventilated and free of insects and bugs. Windows are high up inaccessible to children. The program provides two snacks daily and parents will provide lunch for children each day. Only reusable products will be used for food served by the facility. Facility has a dishwasher to wash items. Snack foods will be stored in the kitchen separately from any cleaning products or other hazards. Medications will be stored in the health office area inaccessible to the children; there is a refrigerator located in this area for refrigerated medications. There are _4 toilets (60 capacity) and 4 sinks (60 capacity) accessible for children's use. Bathrooms are located either inside the classrooms or in the hallway. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran Lo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: POTRERO HILL MONTESSORI SCHOOL	FACILITY NUMBER: 384004643
	VISIT DATE: 01/17/2023

NARRATIVE

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The program will provide a water dispenser and cups for children to drink water indoors. All toxins and other hazardous items will be stored in a locked cabinet in the classroom and will be inaccessible to children. Isolation of ill children will be located in the health office and staff bathroom will be used for an ill child.

Outdoor: The facility does not have outdoor space. Applicant has applied for an open space waiver to use Jackson Park and Playground.

Required postings were observed during today's inspection. Facility will conduct monthly disaster drills and a log will be maintained for review upon request. The fire inspection has been conducted and approved. Applicant has provided STD850 to our office. The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Information was provided to applicants during today's inspection. Advisory Note provided to applicants stating that the requirement for testing must be met by January 2023. Facility was built after 2010.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran Lo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: POTRERO HILL MONTESSORI SCHOOL	FACILITY NUMBER: 384004643
	VISIT DATE: 01/17/2023

NARRATIVE

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Exit interview conducted and report was reviewed with the applicant Liu Yang.

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA has observed playground and Permit has been Provided for facility file.

LPA recommends Licensure effective today for 54 children.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran Lo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

LIC809 (FAS) - (06/04)

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