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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412158
Report Date: 12/09/2022
Date Signed: 12/09/2022 03:37:17 PM

Document Has Been Signed on 12/09/2022 03:37 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PALO ALTO PRESCHOOL BILINGUAL MONTESSORIFACILITY NUMBER:
434412158
ADMINISTRATOR:PULDA, VIRGINIAFACILITY TYPE:
850
ADDRESS:4232 EL CAMINO REALTELEPHONE:
(650) 739-0137
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 118TOTAL ENROLLED CHILDREN: 90CENSUS: 76DATE:
12/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Weija CaiTIME COMPLETED:
03:15 PM
NARRATIVE
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On 12/9/2022 Licensing Program Analyst (LPA) Morgan Pringle met with facility staff Weija Cai for a complaint that was received at the facility. During the inspection there were two seventy-six (76) preschool children, (2) volunteers and nine (9) staff members. During LPA's inspection interviews were conducted and a tour of the facility was taken. LPA obtained the facility roster and personnel roster and obtained a sample of the staff files.

Through LPA's record review it was found that two (2) staff members who were supervising children and volunteers did not have proof of transcripts in their facility file, putting two (2) classrooms, Rooms 1 and Room 2, out of ratio at the time of LPA's visit. Three (3) staff were missing health screening reports, three (3) teachers were missing proof of immunization's and proof of a negative tuberculous (TB) test.

Type B Deficiencies cited
  • Three (3) staff members missing transcripts
  • Three (3) staff missing proof of immunization's
  • Three (3) staff members missing TB test and Heath Screening Report
  • Two (2) classrooms out of ratio

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.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PALO ALTO PRESCHOOL BILINGUAL MONTESSORI
FACILITY NUMBER: 434412158
VISIT DATE: 12/09/2022
NARRATIVE
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A notice of site visit was given to licensee and must be posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Weija Cai

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 12/09/2022 03:37 PM - It Cannot Be Edited


Created By: Morgan Pringle On 12/09/2022 at 02:16 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 PRESCHOOL BILINGUAL MONTESSORI
FACILITY NUMBER: 434412158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
101216.1(g)

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101216.1(g) A photocopy of the teacher's Child Development Permit as specified in (c)(3) above, or a photocopy of the teacher's transcript(s) documenting successful completion of required course work, shall be maintained at the center.
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Facility Director and staff will ensure to obtain all missing transcripts. Proof of correction will be sent to LPA Pringle by POC date.
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This requirement was not met as evidenced by: Three (3) staff members were missing transcripts which poses a potential risk to the health and safety of the children in care.
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Type B
12/16/2022
Section Cited
HSC1596.7995(a)(1)

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1596.7995(a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each...shall receive an influenza vaccination between August 1 and December 1 of each year.
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Facility Director and staff will ensure to obtain all missing immunization records from staff members. Proof of correction will be sent to LPA Pringle by POC date.
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This requirement was not met as evidenced by: Three (3) staff member were missing proof of immunizations which poses a potential risk to the health and safety of the children in care.
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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/09/2022 03:37 PM - It Cannot Be Edited


Created By: Morgan Pringle On 12/09/2022 at 02:24 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 PRESCHOOL BILINGUAL MONTESSORI
FACILITY NUMBER: 434412158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
101216(g)(1)

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101216(g)(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
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Facility Director and staff will ensure to obtain all missing Health Screening Reports and TB tests from staff. If report cannot be completed proof of appointment will be sent to LPA. Proof of correction will be sent to LPA Pringle by POC date.
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This requirement was not met as evidenced by: Three (3) staff members were missing a health screening report and proof of tuberculosis teast which poses a potential risk to the health and safety of the children in care.
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Type B
12/16/2022
Section Cited
CCR101216.3(a)

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101216.3(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement was not met as evidenced by:
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Facility Director will ensure that the facility classrooms are in ratio at all times. Director will report the classroom ratios to LPA Pringle for the next five business days. A statement on how the facility will stay in compliance will also be submitted.
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Room one (1) and room (2) were out of ratio during LPA's visit due to two (2) staff members not having proof of transcripts.
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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022


LIC809 (FAS) - (06/04)
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