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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000481
Report Date: 09/22/2022
Date Signed: 09/22/2022 12:42:47 PM

Document Has Been Signed on 09/22/2022 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BREIDINGER, NADA -LA PETITE MONTESSORI SCHOOL, LLCFACILITY NUMBER:
414000481
ADMINISTRATOR:BREIDINGER, NADA Y.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 401-7789
CITY:HILLSBOROUGHSTATE: CAZIP CODE:
94010
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Nada BreidingerTIME COMPLETED:
01:00 PM
NARRATIVE
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On September 22, 2022, Licensing Program Analyst (LPA) Van performed an annual 1-year mandatory inspection, which included checking the interior and exterior of the facility and discussing the required childcare paperwork. LPA met with the Licensee, Nada Breidinger, and her helper. The facility today has 13 children, all of which were preschool-age children. Children's capacity and ratio did not meet today. The Licensee did not have at least one child enrolled in and attending kindergarten or elementary school or child is at least six years of age when operating 13 or 14 children. In addition, Licensee did not have a copy of documentation verifying that any child currently enrolled or attended kindergarten. Day Care Areas: Day Care Room in the back of the house, bathroom, and deck. Off Limits Areas: The rest of the house. All off-limit locations have been adequately gated. Days and operations are from Monday through Friday, from 8:00 am to 6:00 pm. Child care liability insurance is valid and on file.

LPA inspected the facility's indoor and outdoor areas for health and safety hazards. The childcare area is clean and organized, with age-appropriate toys and equipment. The house has sufficient lighting and ventilation. A functional telephone, working smoke and carbon monoxide detector, and a fully charged fire extinguisher are all in the house. According to the Licensee, there are no bodies of water on the premises. Daycare children have no access to detergents, disinfectants, or cleaning chemicals. The Licensee claims there are no guns or weapons in the house.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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 09/22/2022 12:42 PM - It Cannot Be Edited


Created By: Brendon Van On 09/22/2022 at 11:40 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: BREIDINGER, NADA -LA PETITE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 414000481

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(1)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee/facility did not comply with the section cited above in 13 out of 13 children were preschool-age children. The Licensee did not have a school-age child or child currently enrolled in kindergarten or elementary school, which poses immediate health, safety, or personal rights risk to persons in care.
POC Due Date: 09/23/2022
Plan of Correction
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The Licensee must adhere to her Licensee's limitations and requirements. The Licensee states she will reduce the number of preschool children in her capacity and provide Licensing with a written plan/schedule to comply with her license limitation by September 23, 2022. A written plan and schedule will be sent to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/22/2022 12:42 PM - It Cannot Be Edited


Created By: Brendon Van On 09/22/2022 at 11:40 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: BREIDINGER, NADA -LA PETITE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 414000481

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, both Licensees did not comply with the section cited above. Both Licensees have not completed their Mandated reporter training, which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 09/28/2022
Plan of Correction
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• The Licensee states she will ensure that all current or new staff members complete the mandated reporter training every two years. The Licensee says she will have all staff complete the training by September 28, 2022. A return visit is necessary.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the interview and record review, the Licensee did not comply with the section cited above. 2 out of 10 enrolled children's files did not have records of immunizations, which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 09/28/2022
Plan of Correction
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The Licensee must ensure that children's immunizations are maintained and available for review during the inspection. The Licensee will provide LPA proof of missing children's immunization records no later than September 28, 2022. A return visit is necessary.
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:Brendon Van
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022


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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: BREIDINGER, NADA -LA PETITE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 414000481
VISIT DATE: 09/22/2022
NARRATIVE
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Emergency drills are held at least once every six months. The last drills were conducted on May 16, 2022. However, Licensee did not have the drills documented. The Licensee serves lunch and morning and afternoon snacks. Children's files were reviewed. Two out of ten children were missing immunization records and licensing forms. The missing licensing forms include LIC 995A parent's rights, LIC 627 consent for medical treatment, and LIC 700 emergency identification information. LPA discussed care and supervision with the Licensee. Capacity options were reviewed, and the Licensee acknowledges that care cannot be provided over the capacity specified on the license. LPA reminded that when operating at a maximum of 14 capacity, the 13th and 14th children must be enrolled and attended kindergarten or elementary school. A verification document from the school is required. The requirements for reporting suspected child abuse, as well as reporting requirements for unusual incidents, were discussed. All mandatory postings are posted (License/Parent's Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist).

The facility was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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 the staff and the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Licensee 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.
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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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: BREIDINGER, NADA -LA PETITE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 414000481
VISIT DATE: 09/22/2022
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The incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

The staff was reminded about the Provider Information Notices (PINs) on the CCLD website. Staff was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed AB 1207 with the Licensees. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Effective July 1, 2020, Licensees must have proof of completion of EMSA-certified lead poison training if applying for a change of location or capacity to an existing license.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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: BREIDINGER, NADA -LA PETITE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 414000481
VISIT DATE: 09/22/2022
NARRATIVE
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The facility will send the following documents to San Bruno Child Care Office for the file:
-Updated LIC 610A, LIC 9040 Children roster, Licensee immunization records, and all licensing forms on the checklist.

See next page for deficiencies cited. A Type "A" violation (see continuation) was issued today. The Licensee is informed to provide a copy of the Evaluation Report, and the Type "A" Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report and appeal rights were provided and reviewed with the Licensee. Notice of Site Visit shall remain posted for 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Brendon Van
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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