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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415538
Report Date: 03/15/2023
Date Signed: 03/15/2023 03:08:58 PM

Document Has Been Signed on 03/15/2023 03:08 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:GUIDEPOST MONTESSORI AT PALO ALTOFACILITY NUMBER:
434415538
ADMINISTRATOR:KANG, YING JIAOFACILITY TYPE:
850
ADDRESS:930 EMERSON STREETTELEPHONE:
(650) 382-0550
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 31DATE:
03/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Nicole voghtTIME COMPLETED:
01:15 PM
NARRATIVE
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 On 3/15/2023 at 9:53AM, Licensing Program Analysts (LPA) MIchael Mathew conducted an Unannounced Case Management Visit . LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with director Nicole Vogt and advised her the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 31 children in care and 7 staff at the time of the inspection.

On 2/22/2023, facility Director reported an unusual incident to the Department. The report states that The children were napping and left unsupervised for about 5-10 min. Director stated that
there was mis-communication of who was supposed to be in the room.

1 type B deficiency was cited in today's visit

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 conducted, appeal rights were given, and report was reviewed with director Nicole Vogt

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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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Document Has Been Signed on 03/15/2023 03:08 PM - It Cannot Be Edited


Created By: Michael Mathew On 03/15/2023 at 02:42 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: GUIDEPOST MONTESSORI AT PALO ALTO
FACILITY NUMBER: 434415538

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2023
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.

This requirement was not met as evidenced by:
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Director agreed to send LPA via email implementing a plan to prevent further incidents. by end of day 3/22/23
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On 2/22/2023, Director reported an unusual incident to the Department. The report states that The children were napping and left unsupervised for about 5-10 min. Director stated that
there was mis communication of who was supposed to be in the room.
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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:Wynn Norona
LICENSING EVALUATOR NAME:Michael Mathew
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023


LIC809 (FAS) - (06/04)
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