010210354-8-11-2021-02-CC-MMEA-C5SPUM-20210811113746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010210354
Report Date: 08/11/2021
Date Signed: 08/11/2021 11:37:51 AM

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	GRAND LAKE MONTESSORI		FACILITY NUMBER:	010210354
ADMINISTRATOR:	FAYE OWENS		FACILITY TYPE:	850
ADDRESS:	466 CHETWOOD ST		TELEPHONE:	(510) 836-4313
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94610
CAPACITY:	195	CENSUS: 53	DATE:	08/11/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sid Leck and Joaquin		TIME COMPLETED:	11:50 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A Case Management Visit was conducted on this date 8/11/21 by Licensing Program Manager (LPM), Mayla Mendoza and Licensing Program Analysts (LPAs) Melissa Guirit and Melissa Domantay. LPM and LPAs met with Head of School, Sid Leck and Facilities Manager Joaquin Dehoyos. The center has applied to add a classroom (Rosemary House) to their license with no increase in the number of children they are currently licensed for. A health and safety inspection was conducted inside and outside. The center is currently licensed in 4 Buildings with a total of 8 classrooms (Live Oak, Jacaranda, Juniper, Magnolia, Ginko, Mulberry, Camellia, and Rosemary House). Hours of operation are from 7:00am-6:00pm. The Rosemary House classroom was measured and the new overall indoor measurements are as follows: INDOORS: 6008.512 square feet = 172 children OUTDOORS: 30129.76 square feet = 401 children First aid supplies are available in the center. Facility has functioning carbon monoxide detectors. This facility plans to provide Incidental Medical Services – IMS. A Plan of Operation that includes 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: http://www.ada.gov/childqanda.htm. A review of staff records on 8/11/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GRAND LAKE MONTESSORI	FACILITY NUMBER: 010210354
	VISIT DATE: 08/11/2021

NARRATIVE

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The center has obtained an approved fire clearance for 6 children only in the Rosemary House.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting, COVID 19 protocols, PINs (Provider Information Notices) and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

There were no deficiencies cited during this visit.

A license to add the Rosemary House classroom is effective today, 8/11/21 with a capacity of 172 children.

An exit interview was conducted.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC809 (FAS) - (06/04)

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