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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420932
Report Date: 07/12/2021
Date Signed: 07/12/2021 04:23:55 PM

Document Has Been Signed on 07/12/2021 04:23 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 SCHOOL OF NEWARKFACILITY NUMBER:
013420932
ADMINISTRATOR:GUTIERREZ, DENISE ANNFACILITY TYPE:
850
ADDRESS:35660 CEDAR BLVDTELEPHONE:
(510) 792-4546
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 40TOTAL ENROLLED CHILDREN: 0CENSUS: 16DATE:
07/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Denise Ann GutierrezTIME COMPLETED:
04:40 PM
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On 07/12/2021 at 2:05pm, Licensing Program Analyst (LPA) Jonathan Williams met with Director (Denise Ann Gutierrez) for a Required 1 Year Inspection. Present for this inspection are the Director, two (2) fully qualified teachers, and sixteen (16) children in care, including the daughter of facility Director. Facility operating hours are Monday-Friday from 7:30am-6:00pm. The facility was toured to conduct a Health and Safety Inspection.

At 2:05pm, LPA toured facility classrooms. The classrooms are tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts.

At 2:15pm, LPA toured the outdoor play area. All play equipment was observed to be operable and age-appropriate during this inspection. Areas around swings, slides, and high climbing equipment have cushioning material (poured rubber) to absorb falls. Uncontaminated drinking water is available to children in the outdoor area.

At 2:25pm, LPA reviewed sign-in/sign-out sheet. LPA observed fifteen (15) signatures out of fifteen (15) daychildren present in the facility during today's inspection. Not included in sign-in/sign-out logs is the child of facility Director, present during today's inspection.

At 2:30pm, LPA toured the facility bathroom. Toilets and sinks were found to be in operable condition. LPA observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. No cleaning supplies were observed to be accessible to children during today's inspection.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI SCHOOL OF NEWARK
FACILITY NUMBER: 013420932
VISIT DATE: 07/12/2021
NARRATIVE
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The facility has a fully charged 3A40BC fire extinguisher. Per Director, the facility has a working smoke detector, working carbon monoxide detector, and working telephone. All staff have current CPR/1st Aid and Mandated Reporter Training certificates. The facility is in ratio today, with one teacher supervising no more than 12 children. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view, including menus. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. No Plan for Providing IMS was found to be on file during today's inspection. Director is advised that a Plan for Providing IMS must be submitted to the Department whenever IMS is provided. 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 assistants, volunteers, frequent visitors, or adults present in the facility that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Director was reminded that California Law requires licensed Child Care Centers 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 electronic mail. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: MONTESSORI SCHOOL OF NEWARK
FACILITY NUMBER: 013420932
VISIT DATE: 07/12/2021
NARRATIVE
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One deficiency was cited during today's visit. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Director. LPA reminded the Director to post the Notice of Site Visit where it is clearly visible inside the facility for a period of 30 days after the date of today's inspection. Appeal rights were provided to the Director and the signature on this form acknowledges receipt of these rights.

See LIC809-D for Type B deficiency cited during today's visit.



Exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/12/2021 04:23 PM - It Cannot Be Edited


Created By: Jonathan Williams On 07/12/2021 at 03:54 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 SCHOOL OF NEWARK
FACILITY NUMBER: 013420932

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2021
Section Cited
CCR
101173(c)

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101773 Plan of Operation... (c) Any proposed changes in the plan of operation that affect services to children shall be subject to departmental approval prior to implementation and shall be reported as specified in Section 101212.
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Director shall submit Plan for Providing IMS to Department by the POC due date.
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This requirement was not met as evidenced by: Based on record review conducted by LPA, it was determined that a Plan for Providing IMS had not been submitted to Department for one child in care. This poses a potential risk to the health and safety of children in care.
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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:Wynn Norona
LICENSING EVALUATOR NAME:Jonathan Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2021


LIC809 (FAS) - (06/04)
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