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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412619
Report Date: 03/04/2024
Date Signed: 03/04/2024 03:34:05 PM

Document Has Been Signed on 03/04/2024 03:34 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTESSORI CHILDREN'S CENTERFACILITY NUMBER:
013412619
ADMINISTRATOR:SALVADOR, LULETTEFACILITY TYPE:
830
ADDRESS:33170 LAKE MEAD DRIVETELEPHONE:
(510) 489-7510
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 14DATE:
03/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Lulette SalvadorTIME COMPLETED:
03:45 PM
NARRATIVE
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On 03/04/2024 at 9:50AM Licensing Program Analyst (LPA) Jaleesa Jackson met with Director Lulette Salvador, for an Unannounced Annual/Random Inspection. Two classrooms (Willow and Lenido) were toured for a health and safety inspection. During today's inspection there were 14 infants and 4 staff present. The facility operates from 7:00AM – 6:00PM, Monday – Friday. The facility is dual licensed and holds an preschool license #013412618.

The facility has age appropriate materials in the classrooms that were observed to be clean and in good condition. During todays inspection, all toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. There is at least one (1) fully stocked first-aid kit on site. There were seven cribs all which were clean, well maintained, and free from defects. All cribs had tightly fitting sheets and no loose items were in the cribs. The diapering areas in both classrooms were clean, properly cushioned and free from any defects. The facility has smoke detectors, carbon monoxide detectors and fire extinguishers on site.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. Areas around and/or under climbing equipment, swings and slides have artificial grass cushioning material to absorb a falls. Director states there are no weapons or firearms on the premises.

All food provided by the facility is properly stored and labeled and all food brought from the children’s home is properly labeled and stored in the classrooms. All milk and infant formulas are properly stored and labeled.


Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412619
VISIT DATE: 03/04/2024
NARRATIVE
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LPA reviewed 5 children's files and 3 staff files. LPA found 1 staff file with no MMR on file. The facility is operating within their licensed capacity and is in ratio. All required postings are made visible in the entry way of the facility including the menu. The disaster drills have been complete at least every six months. The last fire drill was 9/22/2023 and the last earthquake drill was 10/2/2023.

There were 1 deficiency cited on today's visit. See 809-D for deficiency.

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.

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.

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 to the Written Directives outlined in PIN 21-21.1-CCP.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.


Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI CHILDREN'S CENTER
FACILITY NUMBER: 013412619
VISIT DATE: 03/04/2024
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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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated 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) 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/.

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



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 Lulette Salvador.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
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Document Has Been Signed on 03/04/2024 03:34 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 03/04/2024 at 02:35 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: 013412619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 staff does not have MMR on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2024
Plan of Correction
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Director is to submit proof of staff member without MMR by email to LPA by POC date.
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:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024


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