<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213903
Report Date: 08/28/2024
Date Signed: 08/28/2024 12:40:33 PM

Document Has Been Signed on 08/28/2024 12:40 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:MONTESSORI SCHOOL AT WASHINGTON AVENUEFACILITY NUMBER:
010213903
ADMINISTRATOR/
DIRECTOR:		YOUSSEF, MARIANFACILITY TYPE:
850
ADDRESS:14795 WASHINGTON AVENUETELEPHONE:
(510) 357-8432
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 111TOTAL ENROLLED CHILDREN: 111CENSUS: 43DATE:
08/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:person incharge- Karina EstevezTIME VISIT/
INSPECTION COMPLETED:
12:50 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
Licensing Program Analyst (LPA) Jyoti Saini met with the person in charge, Karina Estevez, for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the person in charge. In addition to the person in charge, 43 preschool children and six (6) staff members are present today. The facility operates Monday - Friday from 7:00 am to 6:00 pm in four preschool classrooms. The facility was inspected indoors and outdoors today for health and safety hazards, and the following was observed.
 The Center is in good condition with proper temperature and ventilation, and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. Per facility representative, there are no firearms present on the premises. During today's inspection, LPA did not observe any bodies of water.The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition, with sufficient tan bark underneath to absorb the fall.The program provides daily snacks, and the facility requires families to provide lunch for the children. Children bring their water bottles, and the facility refills them using water fountains as needed. Each child has separately labeled cubbies to place their belongings. Each child has separate blankets and sheets. Per facility representative, the parents laundered blankets and sheets weekly. LPA inspected the food storage and reminded the facility to store it in its original packaging or label with the expiration date. The classroom has appropriate postings. The last Emergency Drill was conducted on 08/02/2024 at 10:30 am and is properly logged. The facility uses the Bright Wheel app to sign the children in and out. LPA reviewed the sign-in and out sheet.
LPA reviewed the children's and staff's files. The review of the staff file was complete; however, the children's files were incomplete. The facility is transitioning to an electronic record-keeping system, and the records were found incomplete at the time of inspection. The opening and closing staff have a current Pediatric First Aid/CPR certificate. All the staff members have Mandated Reporter training. Per facility representative, no children are on medications.
see next page..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
Document Has Been Signed on 08/28/2024 12:40 PM - It Cannot Be Edited


Created By: Jyoti Saini On 08/28/2024 at 11:37 AM
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: MONTESSORI SCHOOL AT WASHINGTON AVENUE
FACILITY NUMBER: 010213903

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)
Child's Records
(b) Each record shall contain information including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. The facility is currently transitioning to an electronic record-keeping system. However, the records were found to be incomplete at the time of inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/06/2024
Plan of Correction
1
2
3
4
The facility shall collect all required paperwork from the families enrolled and submit completed paperwork to the department by the due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 AVENUE
FACILITY NUMBER: 010213903
VISIT DATE: 08/28/2024
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
26
27
28
29
30
31
32
During inspection,

Criminal Record Clearance -

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Lead Testing –


CCC COMPLETED TESTING
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS)
This facility provides Incidental Medical Services – IMS. The facility provides the IMS however there are no children enrolled currently.
For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org
Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

see next page..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 AVENUE
FACILITY NUMBER: 010213903
VISIT DATE: 08/28/2024
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
26
27
28
29
30
31
32
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Type B deficiency is cited today, and a technical advisory note was issued.




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


Exit interview conducted and report was reviewed with the facility representative, Karina Estevez.







SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5