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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400025
Report Date: 08/29/2024
Date Signed: 08/29/2024 01:43:42 PM

Document Has Been Signed on 08/29/2024 01:43 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PALO ALTO MONTESSORI SCHOOL INC.FACILITY NUMBER:
434400025
ADMINISTRATOR/
DIRECTOR:		SOMA GUNAWARDENAFACILITY TYPE:
850
ADDRESS:575 ARASTRADERO ROADTELEPHONE:
(650) 493-5930
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 31DATE:
08/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Dinesh PereraTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On August 29, 2024 at 11:00 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Random Inspection and met with the facility representative Dinesh Perera. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. There were 31 preschool age children present during this inspection and three (3) additional staff members. The facility was toured inside and out for a health and safety inspection. The hours of operation are 7:30 AM-5:30 PM, Monday -Friday

LPA checked the facility RECORDS and they show all individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. LPA conducted a census of the children and the census did not match the children signed in on the electronic system. LPA reviewed five (5) children's files and three (3) staff files around 11:15 AM. All staff files have required health screening, and Employee Rights forms, and all children files contains Personal Rights, Medical Consent forms, and Identification & Emergency Information. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate.

The one (1) classroom was inspected around 11:30 AM and teacher child ratio was observed. There are adequate play and learning materials available. The floors are well maintained and the furniture is the correct size for preschool children. The classrooms equipment is in good repair and the room temperature is adequate for children in care. There is proper individual storage space for each child and they have lockers outside and hooks to hang their belonging around the center. The isolation area for sick children is the bench outside the bathroom, away from other children in care.

LPA tested the smoke & carbon monoxide detector in the classroom and found them to be functioning properly. The center has a working telephone, pull down fire alarm system, and a fully charged 3A40BC fire extinguishers, which meets standards established by the State Fire Marshal. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 08/09/2024. All required documents are posted in a public accessible area.

See 809-C.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PALO ALTO MONTESSORI SCHOOL INC.
FACILITY NUMBER: 434400025
VISIT DATE: 08/29/2024
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The parents provide snacks and lunch for their own children but the center have snacks readily available in case of an emergency. LPA observed an area where they have a refrigerator this area is clean and free of evidence of rodents. LPA reminded the facility representative that all persons engaged in food preparation and service shall observed personal hygiene and food service sanitation practices to protect food from contamination. All storage containers for solid waste have tight fitting covers that are in good repair.

LPA’s observations during the visit

At 11:00 AM, when I arrive at the facility the children were on the playground running, jumping, and playing with each other on the climbing structure and other playground equipment. There were three staff members located around different areas of the playground watching the children. The children were very curious of me and kept asking me what was I doing here? so I replied, I was inspecting the facility to make sure everything was safe for children.

At 11:30 AM, LPA inspected the outdoor play area and it has a play structure with a slide that has sand underneath it to absorb children's falls. There are multiple canopies that provides shade to children while at play and a the staff brings the children's water bottles to the yard to keep them hydrated. The play equipment is age appropriate and in good repair. The outdoor play area is fully fenced and free of defects and dangerous condition. There are multiple cabinets with locks to prevent children access to equipment in the cabinets on the playground.



LPA checked the staff bathroom around 12:00 PM, and was told by the representative that in the winter months children can use it because it has a toilet made for them. The children's bathroom is located in the building to the far right of the classroom and all of sinks and faucets are in safe and sanitary operating condition. LPA Woods flushed each of the toilets to make sure that they were operating correctly and they were. LPA also checked the sinks to make sure the water temperture wasn't too hot for them and it wasn't. Paper towels and soap are available to the children.

The following deficiencies were observed during today's inspection: CCC
· At 11:40 AM, LPA observed that several children were not sign in on the electric sign in system.

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PALO ALTO MONTESSORI SCHOOL INC.
FACILITY NUMBER: 434400025
VISIT DATE: 08/29/2024
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Lead Testing – Child Care Centers (CCC) CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/



To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

See 809-D for deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Dinesh Perera.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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Document Has Been Signed on 08/29/2024 01:43 PM - It Cannot Be Edited


Created By: Elimika Woods On 08/29/2024 at 01:17 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PALO ALTO MONTESSORI SCHOOL INC.
FACILITY NUMBER: 434400025

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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Director will ensure that all children are signed in properly. Director will send LPA Woods a statement including the number of children present and the number of children present for the day and the number of children signed in.
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:Chandra Charles
LICENSING EVALUATOR NAME:Elimika Woods
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024


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