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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420951
Report Date: 04/23/2024
Date Signed: 04/23/2024 05:29:13 PM

Document Has Been Signed on 04/23/2024 05:29 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GLOBAL MONTESSORI INTERNATIONAL SCHOOLFACILITY NUMBER:
013420951
ADMINISTRATOR/
DIRECTOR:		TENG, VIVIFACILITY TYPE:
850
ADDRESS:2830 - 9TH STTELEPHONE:
(510) 845-6969
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 90TOTAL ENROLLED CHILDREN: 40CENSUS: 29DATE:
04/23/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:58 PM
MET WITH:Eli HernandezTIME VISIT/
INSPECTION COMPLETED:
05:35 PM
NARRATIVE
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On April 23, 2024 at 3:58pm Licensing Program Analyst (LPA) Indira Loza met with Office Manager Eli Hernandez for a Case Management inspection regarding lead testing. Present during today's inspection were 29 children and 3 staff. LPA toured the facility for a Health and Safety check. According to the Written Directives, all centers constructed before 2010 were to have the water outlets used for drinking and/or food preparation tested by January 1, 2023.

The center operates out of three (3) classrooms. The facility uses tap water from the classrooms and the kitchen to use for food preparation and drinking water. During the tour of the facility Office Manager Hernandez pointed out which faucets are used for drinking and food preparation. There were two (2) faucets in each class and the faucet in the kitchen that were identified as being used to wash dishes, prepare food, and to use as drinking water. LPA observed a drinking fountain in the main hallway and Office manager Hernandez stated the fountain is not used by children to drink. The drinking fountain in the hallway needs to either be tested for Lead or be covered to prevent a child from drinking from it.

See LIC809-D for the Type B citation issued during today's visit.

Exit Interview Conducted.
Report and Appeal Rights were reviewed and provided to Office Manager Eli Hernandez.
Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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Document Has Been Signed on 04/23/2024 05:29 PM - It Cannot Be Edited


Created By: Indira Loza On 04/23/2024 at 04:56 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GLOBAL MONTESSORI INTERNATIONAL SCHOOL
FACILITY NUMBER: 013420951

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2024
Section Cited
HSC
1597.16(a)(1)

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(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after
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The Director shall arrange for the testing of all water outlets used for drinking and food preparation, no later than May 23, 2024.
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the date of the initial test. This requirement was not met as evidenced by: Based on record review and interview, it has been determined that the facility did not test the water used for drinking and food preparationd for lead, which poses a potential health, safety, and personal rights risk to 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:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024


LIC809 (FAS) - (06/04)
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