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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004506
Report Date: 11/17/2022
Date Signed: 11/17/2022 03:57:59 PM

Document Has Been Signed on 11/17/2022 03:57 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:LAKEVIEW MONTESSORIFACILITY NUMBER:
414004506
ADMINISTRATOR:BRAMHE, SHEILAFACILITY TYPE:
850
ADDRESS:31 VISTA AVENUETELEPHONE:
(650) 578-9532
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 61TOTAL ENROLLED CHILDREN: 61CENSUS: 38DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Fidaa AslamTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced annual inspection. LPAs met with Teacher Fidaa Aslam and explained purpose of the inspection. Facility runs a preschool program with a toddler option in classrooms 2, 3, and 4 and a school aged program under license #414004507. Present at the facility were seven teachers and 38 children (16 toddlers and 22 preschool aged). Center is operating within capacity limits and in compliance with staff to child ratio. Hours of operation are Monday to Friday from 8:30am to 5:30pm. Facility provides a half day and a full day program.

LPA inspected indoor and outdoor areas of school with Teacher. There are no bodies of water, firearms, or weapons on the premises. Classrooms are in good condition with proper temperature and ventilation and are free of any hazards. Furniture in classrooms are in good repair. Classrooms have age appropriate toys and equipment. Napping mats are in good condition and are properly stored when not in use. Each classroom has its own bathroom with two toilets and two sinks. Bathrooms appear to be clean, in good repair, and free of any hazards. There is a separate bathroom for staff usage. The outdoor play area is fenced for supervision with age appropriate toys and equipment in good condition. The play structure is age appropriate and in good condition with sufficient cushioning underneath.

All required postings and waiver are posted in the front entrance of the facility. Menu is posted for the month. Facility provides lunch and morning and afternoon snacks. Drinking water is available for children indoors and outdoors. Food preparation area is clean and free of any toxins or contamination. All food is properly stored to avoid contamination. All storage containers for solid waste have a proper lid. All cleaning products, chemicals, and toxins are inaccessible to children.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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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: LAKEVIEW MONTESSORI
FACILITY NUMBER: 414004506
VISIT DATE: 11/17/2022
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Last emergency drill was conducted in November 2022. Emergency drills are conducted every month and are properly logged. Paper sign-in/out sheets are located inside a binder at the entrance of the school. The center has a complete paper record of sign-in/out sheets by authorized pickup person. There is a working fire alarm and sprinkler system throughout the center. A carbon monoxide detector and a fully charged fire extinguisher is in each classroom and a working telephone is available on-site.

Nine children records reviewed were complete. All children have a record of emergency identification information on file. Five staff records reviewed were complete. All staff have a criminal record clearance on file. Appointed staff have current pediatric first aid/CPR certificate on file.

No deficiencies cited today under California Code of Regulations, Title 22, Division 12.

Facility representative was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years by all staff. Training can be taken online at www.mandatedreporterca.com. If training is not available in native language, a statement can be written stating exemption until translation is available.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 (US DOJ) 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: http:://www.ada.gov/childqanda.htm.

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.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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: LAKEVIEW MONTESSORI
FACILITY NUMBER: 414004506
VISIT DATE: 11/17/2022
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Facility representative was reminded that all adults 18 and over, 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 Facility Representative 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 Facility Representative 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Facility Representative Fidaa Aslam.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
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