010208784-6-20-2022-02-CC-CFES-CFKVZB-20220620165229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010208784
Report Date: 06/20/2022
Date Signed: 06/20/2022 04:52:36 PM

Document Has Been Signed on 06/20/2022 04:52 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	MOUNTAIN BOULEVARD MONTESSORI SCHOOL		FACILITY NUMBER:	010208784
ADMINISTRATOR:	WANKEN, DENNIS		FACILITY TYPE:	850
ADDRESS:	4432 MOUNTAIN BOULEVARD		TELEPHONE:	(510) 482-2850
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 0	DATE:	06/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:23 PM
MET WITH:	Dennis Wanken		TIME COMPLETED:	05:05 PM

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	On 6/20/2022 at 1:23pm Licensing Program Analysts (LPAs) Catherine Fernandes and Indira Loza met with Director Dennis Wanken for an Unannounced Required Annual Inspection. There were no children in care during the inspection. The center was toured for a health and safety inspection. The facility operates from 7:30am – 5:30pm, Monday through Friday. The center operates out of a converted home, with six rooms, three toilets and three sinks. There are six rooms that have been broken up into different areas of learning, however there are three classrooms. All sinks and toilets are observed to be clean and in proper working order. The facility has age appropriate materials in all classrooms that are observed to be clean and in good condition. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. There is water available for the drinking both inside and outside. There is a working carbon/smoke detector and a fully charged fire extinguishers. The fire system is a pull down alarm. The outdoor play area is broken into three areas that are all fenced, clean with age appropriate materials for the children. There is a play structure that is anchored into the ground. There is shade available for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility. The isolation area will the Director's office. All proper postings are posted. The center does not provide lunches however snacks are provided and a current menu is posted. The fire/disaster drill log was complete with the last drill logged 6/3/2022. LPAs reviewed all of the current staff records and six children's files. LPAs obtained a current children's roster. Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was also informed 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. Report continues on 809C

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

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: MOUNTAIN BOULEVARD MONTESSORI SCHOOL	FACILITY NUMBER: 010208784
	VISIT DATE: 06/20/2022

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Director was reminded that California Law requires all facilities 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 email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov.

This facility at this time is not providing Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

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 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Director Dennis Wanken
Report and appeal rights provided

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC809 (FAS) - (06/04)

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