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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004260
Report Date: 11/29/2023
Date Signed: 11/29/2023 02:04:01 PM

Document Has Been Signed on 11/29/2023 02:04 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: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: 31DATE:
11/29/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Angela TangTIME COMPLETED:
02:10 PM
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On 11/29/2023 at 1:30PM Licensing Program Analyst (LPA) Luis J. Gomez met with Angela Tang. Purpose of the inspection was explained and was for an unannounced, plan of correction inspection established on 9/28/2023. Present was the director and three staff supervising 31 children. Children present had been signed in. LPA inspected facility, indoors and outdoors for health and safety hazards.

During inspection, LPA conducted record review, observations, and interviews.



Per director, new protocol for staff includes review of facility's outside play yard for potential health and safety hazards. Per director, staff are to remove hazardous items, morning prior to opening and provide initials on daily checklist.

LPA inspected the outside play yard. Tricycles and playthings inspected were in good repair. Area was completely enclosed with tall fencing. Absorbent material (tanbark) is located around and underneath play structure. Accessible drinking water is made available with labeled bottles.

Deficiency issued on 9/28/2023, have been cleared, and ‘Cleared Plan of Correction Letters’ provided.

Based on today's inspection, no deficiencies were cited in the areas evaluated according to the Title 22 Division 12 Code of Regulations. Exit interview, and inspected report was discussed with Director, Angela Tang. Signature of this form acknowledges receipt of these documents.

This report must be available in the facility for public review. Notice was provided and shall remain posted for 30 days. Director was advised for additional questions to call CCL Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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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