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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422452
Report Date: 07/22/2021
Date Signed: 07/22/2021 11:41:14 AM

Document Has Been Signed on 07/22/2021 11:41 AM - 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:CRYSTAL GARDEN MONTESSORIFACILITY NUMBER:
013422452
ADMINISTRATOR:HUA-HSIN(CYNTHIA),WANFACILITY TYPE:
850
ADDRESS:37531 FREMONT BLVD.TELEPHONE:
(510) 792-8415
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 28TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Wan Hua-HsinTIME COMPLETED:
11:45 AM
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On July 22, 2021 at approximately 8:40am Licensing Program Analyst (LPA) Russ Haderer arrived to conduct an unannounced required 1-year site inspection for this preschool facility. LPA met with facility director, Wan Hua-Hsin and toured all areas licensed for use by children in care for a health and safety inspection. Also present at the time of this inspection was 1 teacher and 6 children in care (all preschool age two 3y olds; one 4 yr old; three 5 yr olds). The facility is within ratio and capacity. All adults present are background cleared and associated to this facility.

The facility is an older home converted to childcare consisting of 6 rooms: 2 playrooms, 1 Arts & Crafts room; snack room and a group music room: and an off-limits food preparation area and a small office and 2-car garage in playground area outside. The outdoor area has a pull through driveway for child drop off and pick up and swinging gates that are closed when children enter the gated playground space in the back of the facility on the west side.

The facility has 2 2A10BC fire extinguishers, both fully charged with the last annual inspection done in October 2020. There are working smoke alarm and carbon monoxide detectors (tested and working). Heating and ventilation was acceptable.

The school provides lunches and snacks, a menu is posted. The food prep kitchen area is off limits to children, there were no sharp knives observed in the kitchen today. Cleaning chemicals and other cleaners are stored under the sink.

Licensee has current CPR/1st Aid certificates and Mandated Reporter: CPR/1st Aid expires 02/13/2023, Mandated Reporter completed 3/25/2020. Teacher Chang MR completed 3/19/2020
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2021
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 3
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: CRYSTAL GARDEN MONTESSORI
FACILITY NUMBER: 013422452
VISIT DATE: 07/22/2021
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The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. There were no hazardous items/toxins observed to be accessible to children in care today. There are no bodies of water accessible to children in care. All hazardous materials and toxins are kept out of the reach of children.

Disaster drills are conducted once per month, the last drill was conducted in June 2021.

Outside the bathroom there is a changing table that is arm’s length to the sink. The sinks have functioning cold water taps with appropriate hand washing signs. There are two touch-free trash cans with a lid and sufficient amount of towels, soap and diaper supplies. The toilets, hand washing and cleaning areas are fully operating and in safe and sanitary condition.

The sign in/out sheets were reviewed. All children present were signed in. Classrooms have trash cans for the disposal of solid waste. The facility does not have any children that require incidental medication (EpiPen’s, inhalers and anti-histamines for allergies).

The children's napping areas are clean and organized with sleeping pads and cubbies for the children's personal items, none of the children's blankets were touching.

There is a large playground area surrounded by a 6 foot privacy fence, secured with gates with inside latches too high for children to reach. All play equipment is in safe condition and free from sharp, loose or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. Shade was available in the play areas and teachers are always present. Children bring their own bottled water from home and it is made available to them.

At approximately 10:44am LPA performed children's record reviewed: LPA requested and reviewed facility roster. All files selected were complete and up to date and found to be in compliance with Title 22 regulations.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: CRYSTAL GARDEN MONTESSORI
FACILITY NUMBER: 013422452
VISIT DATE: 07/22/2021
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At approximately 11:00 am LPA performed staff file review. All staff subjected to criminal review have been cleared and associated to the facility. All files were complete, up to date and found to be in compliance with Title 22 regulations.

Documents were posted in public places as required:
- Facility License
- Emergency Evacuation Plan
- Earthquake preparedness Notice
- Personal Rights
- Parents Rights
- Child Passenger Safety Laws
- There is a waiver for the bathroom that was not posted, licensee reminded to post all waivers and exceptions.

There were no deficiencies cited today. A copy of this report to remain on file for 3 years. Exit interview was conducted with site Director.

A site visit notice was printed and is required to be posted for 30 days.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
LIC809 (FAS) - (06/04)
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