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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412618
Report Date: 03/18/2022
Date Signed: 03/18/2022 02:54:24 PM

Document Has Been Signed on 03/18/2022 02:54 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTESSORI CHILDREN'S CENTERFACILITY NUMBER:
013412618
ADMINISTRATOR:KHAN, YASMINFACILITY TYPE:
850
ADDRESS:33170 LAKE MEAD DRIVETELEPHONE:
(510) 489-7510
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 110TOTAL ENROLLED CHILDREN: 73CENSUS: 50DATE:
03/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Yasmin KhanTIME COMPLETED:
03:15 PM
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On 03/18/2022 at 8:50am Licensing Program Analyst (LPA) Kelly Phan conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION. LPA Phan met with Yasmin Khan (Director) and Injerdit Kaur (Assistant Director), also present at the time of this inspection were 12 staff and 50 preschool aged children. The facility is within ratio and capacity compliance today. The facility was toured to conduct a Health and Safety Inspection. This program current operates Monday-Friday 7:00am-6:00pm out of three classrooms (Evergreen, Sequioa, and Redwood)

All classrooms were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces with working sinks but had 1 toliet that was not flushing properly in Sequioa classroom. Cots and bedding are changed every Friday and given to families to clean. The presence of working carbon monoxide detector, smoke detectors/fire alarms and a fully charged fire extinguishers size 3A-40-BC that is accessible throughout the facility. The outdoor play area is fully fenced and have shade. There is padding under/around the climbing equipment along with grass near play structures. LPA observed the play structures to be fully intact. There are two plastic rock play structures that had handles that were ripped on both sides. LPA informed staff that drinking water will need to be accessible to children both indoors and outdoors, as no water bottles were present during outdoor activity. There are no pools, hot tubs or other accessible bodies of water. Per director, there are no firearms or smoking present on the premises. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. The facility serves lunch, morning, and afternoon snack, menu is also posted but has not been updated since 02/12/2019. LPA reviewed storage of food and reminded director that all food must be in original packaging or labeled with expiration dates. The center also conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on 02/07/2022. However one classroom (Evergreen) had a drill that was last conducted on 2/11/2020.

SEE LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 03/18/2022 02:54 PM - It Cannot Be Edited


Created By: Kelly Phan On 03/18/2022 at 01:07 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: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above 2 plastic rock play structures had visual defects, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/08/2022
Plan of Correction
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Director will need to call maintence team to remove play structures
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jason Jang
LICENSING EVALUATOR NAME:Kelly Phan
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022


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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412618
VISIT DATE: 03/18/2022
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A copy of the facility personnel roster and children’s roster were available for review and copy was obtained. LPA reviewed the file of 18 children and 6 staff members files, who are fingerprint cleared and associated to the facility. However all staff does not have updated mandated reporter training and proof of flu shots. All staff have current CPR/First Aid certificates, and proof of education and/or experience was also present. LPA also reviewed the sign in/out sheet that shows 50 signatures for 50 children present at the facility. However, some signatures did not have correct dates/times. LPA also reviewed emergency kits that has all appropriate items in each classroom along with allergy lists. Prescribed and non-prescribed medications were missing not in original containers and missing some labels along with consent forms in children's files. Staff interview also conducted and documented.

There is a Type B deficiency cited today. As LPA observed two plastic rock structures that had visual defect such as tarp that are ripped and ropes that were dangling that could pose a potential risk to child's safety. SEE LIC 809 D. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirement shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the facility director, Yasmin Khan

This facility does not provides Incidental Medical Services – IMS. 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

SEE LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412618
VISIT DATE: 03/18/2022
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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.


Facility Representative 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.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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