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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004260
Report Date: 02/17/2023
Date Signed: 02/17/2023 12:40:37 PM

Document Has Been Signed on 02/17/2023 12:40 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 CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:EDISON MONTESSORI SCHOOLFACILITY NUMBER:
414004260
ADMINISTRATOR:ANGELA TANGFACILITY TYPE:
850
ADDRESS:303 TWIN DOLPHIN DRIVE, # 104TELEPHONE:
(650) 593-6824
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94065
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 29DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Angela TangTIME COMPLETED:
12:45 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 2/17/2023 at 8:45AM., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Angela Tang. Purpose of the inspection was explained and was for an unannounced; Annual/ Random inspection. Facility is licensed to operates preschool program. Present was the directors and four staff supervising 29 children. Program operates two classrooms and one, shared outdoor play yard. Days and hours of operation are Monday- Friday 7:00am- 6:00pm. Program operates year-round. Facility was inspected, indoors and outdoors, with director for health and safety hazards

At 9:00AM., LPA observed the following: Classrooms were orderly with age-appropriate plaything and materials available to the children. Floors and ground surfaces were free of obstructions. Individual cubbies are located in classroom for child’s belongings. Furniture and supplies inspected were in good repair and free of sharp corners or splinters. Each classrooms has child sized tables and chairs for seated activities. Children’s bathrooms have adequate supplies for hand washing. Fixtures tested were in operating condition. LPA reminded director to ensure visual supervision is provided at all times. Diaper changing table is available. Per director, changing table is disinfected after each use.

At 9:10AM., Based on observations, LPA confirmed an abundance of dust and particle build-up behind dryer.

Staff bathroom is located separately. For napping services, program provides napping cots for each child. Per director, napping supplies are taken home weekly by families to be washed. Classrooms have acceptable ventilation and lighting. Toxins, detergents, cleaning supplies and are stored inaccessible to children. Classrooms have built-in smoke detectors, telephone service, and fully charged fire extinguishers (3A:40BC). First aid kit was fully stocked.

At 9:40AM., Based on observations, LPA confirmed facility's carbon monoxide detector was not in operating condition.

During inspection, LPA inspected the outdoor play areas. Outdoor play areas were enclosed with tall fencing. Outdoor space was observed free of debris or hazardous objects.

LPA reminded director to remove/ repair broken playthings and repair missing window. Advisory Note: Technical Violation (LIC9102TA) was issued.

Water services are provided inside and outside with accessible water fountains.


(REFER TO 809-C FOR CONT.)
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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 9
Document Has Been Signed on 02/17/2023 12:40 PM - It Cannot Be Edited


Created By: Luis Gomez On 02/17/2023 at 11:20 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: EDISON MONTESSORI SCHOOL
FACILITY NUMBER: 414004260

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 10:30AM., Based on record review, interviews and observations, LPA confirmed staff member, S1, present without proper facility association. This poses an immediate health and safety risk to children in care.
POC Due Date: 02/20/2023
Plan of Correction
1
2
3
4
Director will ensure staff member, S1, receives criminal record clearance and facility association by the due date: 2/20/2023. Proof of correction will be submitted to the department via email.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Ali Zebila
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023


LIC809 (FAS) - (06/04)
Page: 2 of 9
Document Has Been Signed on 02/17/2023 12:40 PM - It Cannot Be Edited


Created By: Luis Gomez On 02/17/2023 at 11:20 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: EDISON MONTESSORI SCHOOL
FACILITY NUMBER: 414004260

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 9:40AM., Based on observations, LPA confirmed facility's carbon monoxide detector was not in operating condition. This poses a potential health and safety risk to children in care.
POC Due Date: 02/17/2023
Plan of Correction
1
2
3
4
Deficiency was cleared during inspection.
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 10:15AM., Based on interview and record review, LPA confirmed facility in not conducting or documenting emergency disaster drills every six months. This poses a potential health and safety risk to children in care.
POC Due Date: 02/22/2023
Plan of Correction
1
2
3
4
Director will conduct and document disaster drill by the due date: 2/22/2023. Proof of correction will be submitted to department via email.
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:Ali Zebila
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023


LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 02/17/2023 12:40 PM - It Cannot Be Edited


Created By: Luis Gomez On 02/17/2023 at 11:20 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: EDISON MONTESSORI SCHOOL
FACILITY NUMBER: 414004260

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
At 9:10AM., Based on observations, LPA confirmed an abundance of dust, debris and particle build-up behind dryer. This poses a potential health and safety risk to children in care.
POC Due Date: 02/22/2023
Plan of Correction
1
2
3
4
Facility will remove all dust, debris from behind dryer by the due date: 2/22/2023. Proof of correction will be submitted to the department via email.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Ali Zebila
LICENSING EVALUATOR NAME:Luis Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023


LIC809 (FAS) - (06/04)
Page: 4 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: EDISON MONTESSORI SCHOOL
FACILITY NUMBER: 414004260
VISIT DATE: 02/17/2023
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
26
27
28
29
30
31
32
(Page 2)
At 10:05AM LPA review facility records including five children’s files and five personnel files. Staff files reviewed included the Personnel Record (LIC501); and Transcripts. LPA reminded director to ensure staff's proof of required immunization, and the ‘Mandated Reporter Training’ certifications are stored in the facility file.

At 10:30AM., Based on record review, interviews and observations, LPA confirmed staff members, S1, present without proper facility association.

Children’s files reviewed and included: Updated Immunization Records, Identification of Emergency Information (LIC700); Personal Rights (LIC613A); and Notification of Parent’s Rights (LIC995).

At 10:15AM., Based on interview and record review, LPA confirmed facility in not conducting or documenting emergency disaster drills every six months.

Per director, facility provides food services including snacks. Kitchen area inspected was clean and in proper use.

LPA observed required posting including the: Facility License, Parent’s Rights (PUB393), Emergency Disaster Plan (LIC610). LPA reminded licensee to post updated snack menu for families.

LPA reviewed children’s medication during inspection. Reminded facility to have drinking water tested for lead. Provider Information Notice: 21-21 was provided during inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manuel – Regulations Interpretations and Procedures for Child Care Centers Section 101173 and 101226. When an IMS is provided, an updated Plan of Operations that includes IMS must be submitted to the Department. Following information regarding ADA was provided: US Department of Justice (USDOJ) toll- free ADA information line at (800) 514- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm (REFER TO 809C FOR CONT.)

SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: EDISON MONTESSORI SCHOOL
FACILITY NUMBER: 414004260
VISIT DATE: 02/17/2023
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
26
27
28
29
30
31
32
(Page 3)
Based on today's inspection, deficiencies were observed in the areas evaluated according to the Title 22 Division 12 Ca. Code of Regulations and cited on 809D. Exit interview, plan of correction, appeal rights and report was reviewed with director, Angela Tang, and signature of this form acknowledges receipt of these documents.

Type “A” violation was issued today. Licensee was advised to provide a copy of the Evaluation Report and all Type “A” Deficiencies cited, to 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 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all children's files.

A civil penalty of $400.00 was assessed.

This report and rights to comment were discussed. This report must be available in the facility for public review. Notice was given and must remain posted for 30 days. Facility was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
Page: 9 of 9