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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004704
Report Date: 12/06/2021
Date Signed: 12/06/2021 02:15:05 PM

Document Has Been Signed on 12/06/2021 02:15 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:BERESFORD MONTESSORI ACADEMY INC.FACILITY NUMBER:
414004704
ADMINISTRATOR:ANA CARDENASFACILITY TYPE:
850
ADDRESS:1051 SOUTH CLAREMONT STREETTELEPHONE:
(650) 578-8925
CITY:SAN MATEOSTATE: CAZIP CODE:
94402
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 35DATE:
12/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Ana Cardenas, Karina Barbera GarciaTIME COMPLETED:
02:20 PM
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On 12/6/2021 at 9:25A.M., Licensing Program Analyst (LPA), Luis J. Gomez met with Director, Ana Cardenas. Licensee, Karina Barbera arrived during inspection. Purpose of the inspection was explained and was for an unannounced Annual/ Random inspection. Facility operates a Preschool Program. Present was the Licensee, Director and 5 staff supervising 35 children. Children present are preschool age. All staff had their criminal record clearances on file. Program utilizes two classrooms: Watermelon (2- 5 years old), Blueberry (2- 5 years old) and one outdoor play yard. Hours of operation are Monday- Friday 8:30am- 5:00pm. Program operates year around. LPA inspected facility, indoors and outdoors, with director for health and safety hazards.

At 9:30A.M., LPA observed the following: Classrooms were clean and orderly with a variety of age-appropriate supplies for the children. All floors and surfaces were free of obstructions. Entry way had labelled cubbies for storage of children's belongings. Accessible furniture was in good repair. Classroom manipulative were free of sharp edges or splinters. Classrooms had child sized tables and chairs for activities. Children's bathroom and all fixtures were in operating condition. (4 toilets, 6 sinks) Bathrooms had adequate supplies for the children. Staff restroom is located separately. For napping services, program provides cleanable mats, which are assigned to each child. Per licensee, children's napping supplies are taken home daily. Classrooms had acceptable ventilation and lighting. Detergents, cleaning supplies and toxins are made inaccessible, stored in an off-limits area. All trash bins and outlets are properly covered. Facility has a smoke/ carbon monoxide detector combo and fully charged fire extinguishers (3A:40BC) located in the classroom. (REFER TO 809-C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2021
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 3
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: BERESFORD MONTESSORI ACADEMY INC.
FACILITY NUMBER: 414004704
VISIT DATE: 12/06/2021
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(Page 2)
At 10:00A.M., LPA inspected the outdoor play area. Outdoor yard was completely enclosed with tall fencing and equipped with proper shading. Area was free of debris or hazardous items. Playthings inspected were is good repair. Play structure was in good condition and was properly anchored. Per licensee, water service is provided using children's refillable water bottles and brought from home. Facility water cart is wheeled out during outdoor activity.

At 10:30A.M., LPA review facility records including ten children’s files and ten personnel files. Children files reviewed were complete and included: Health History (LIC702), Consent for Medical Treatment (LIC627), Identification of Emergency Information (LIC700) and Immunization Records. Staff files reviewed and included: Proof of Immunization, Health Screening (LIC503), Declaration to Report Suspected Child Abuse (LIC9108) and Notice of Employee Rights (LIC9052). Staff's mandated reporter training certifications were current and on file.

Present staff members had their current CPR/ 1st aid certification, which expires: 3/2022. Emergency drills are conducted at the facility, with the last drill done on 7/1/2021, properly logged. Per Director, parents provide meals for day-care children. Facility provides two daily snack for children. Updated snack schedule was observed during inspection. Facility kitchen, refrigerator and food containers were reviewed during inspected. All food inspected was current and properly stored. All required posting were observed in the facility and included the License, Parents Rights (PUB393), Emergency Disaster Plan (LIC610). During inspection, LPA reviewed children’s medication stored in the facility.

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 809-C FOR CONT.)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: BERESFORD MONTESSORI ACADEMY INC.
FACILITY NUMBER: 414004704
VISIT DATE: 12/06/2021
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Director 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 Child Care Center. A civil penalty of $100.00 minimum/ day up to $500.00 maximum per day/per person will be assessment if this regulation is violated.

Based on today's inspection, no deficiencies were observed in the areas evaluated according the Title 22 Division 12 Ca. Code of Regulations. Exit interview was discussed with Director, Ana Cardenas and Licensee, Karina Barbera Garcia and their signature of this form acknowledges receipt of these documents.



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: Cindy Interiano
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
LIC809 (FAS) - (06/04)
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