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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213903
Report Date: 04/26/2023
Date Signed: 04/26/2023 11:34:13 AM

Document Has Been Signed on 04/26/2023 11:34 AM - 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:MONTESSORI SCHOOL AT WASHINGTON AVENUEFACILITY NUMBER:
010213903
ADMINISTRATOR:YOUSSEF, MARIANFACILITY TYPE:
850
ADDRESS:14795 WASHINGTON AVENUETELEPHONE:
(510) 357-8432
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 111TOTAL ENROLLED CHILDREN: 111CENSUS: 72DATE:
04/26/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director, Marian YoussefTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Jyoti Saini met with Director Marian Youssef to conduct a Case Management inspection for the Lead Testing results at this facility. In addition to the director, there are 72 children and 9 staff members present today. The facility operates Monday - Friday from 7:00am to 6:00pm.

LPA conducted an inspections and Inspected the facility for health and safety. It was concluded that one outlet exceeded the Action Level that was established by the state for exposure, however the classroom (Room 2) which the faucet with an ALE is located in has never been used for drinking or food preparation.

To correct the exceedance , the facility has already replaced the water outlet and have scheduled retesting. LPA obtained photos of the faucet that has exceeded 5.5 ppb. LPA obtained the documentation for the post-testing requirements.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Marian Youssef.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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