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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422452
Report Date: 06/15/2022
Date Signed: 06/15/2022 12:26:44 PM

Document Has Been Signed on 06/15/2022 12:26 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: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: 7CENSUS: 5DATE:
06/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Hua-Hsin (Cynthia) WanTIME COMPLETED:
12:35 PM
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On June 15, 2022 at approximately 8:30am Licensing Program Analyst (LPA) Russ Haderer arrived to conduct an unannounced site inspection for health and safety. The new CARE tool was used for the inspection. LPA met with facility director, Hua-Hsin (Cynthia) Wan and toured all areas licensed for use by children in care. Also present at the time of the inspection 1 teacher assistant and 5 children in care (one 23 month old infant; two 2 years-old; one 4 years-old; one 6 years-old). The facility is within ratio and capacity. The hours of operation remain 8:00 to 6:00pm.

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. Heating and ventilation is acceptable.

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 playground area is surrounded by a 6 foot privacy fence. 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.

The facility has a fully charged 2A10BC fire extinguisher, the last annual inspection done October 20, 2021. There are working smoke and carbon monoxide detectors (tested and working). Disaster drills are conducted once per month, the last drill was conducted May 20, 2022.



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 out of the reach of children.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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: CRYSTAL GARDEN MONTESSORI
FACILITY NUMBER: 013422452
VISIT DATE: 06/15/2022
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The facility is clean and well organized with age appropriate furnishings and equipment in good repair. Surfaces including floors and counter tops are clean and toxic free. There are ample age-appropriate toys that appear to be safe and in good condition. There are no bodies of water accessible to children in care. Classrooms have touchless trash cans with tight fitting cover for the disposal of solid waste. There were no hazardous items/toxins observed to be accessible to children in care today.

There is 1 child’s bathroom with two toilets and two sinks and a changing table outside of the bathroom. The sinks have functioning cold water taps with appropriate hand washing signs. There is a touch-free trash can with a lid and sufficient amount of towels, soap and diaper supplies. All toilets, hand washing and cleaning areas are in safe and sanitary operating condition.

The sign in/out sheets were reviewed. All children present were signed in.

All Documents required to be posted in public places were present.

Uncontaminated drinking water is provided. Lead testing was completed on the facility on December 18, 2021, Water Sampling certification forms LIC9275 and LIC9276 are available.

Staff files were reviewed. All files were complete and in good order. Center Director CPR/1st Aid expires 02-23-2013 and Mandated Reporter certificate expires 03/27/2024. Assistant does not have CPR/1st Aid certificate, Mandated Reporter expires 04/17/2024.

Children's records were reviewed: LPA requested and reviewed facility roster and took a copy. All children’s records were complete and in good order.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
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: CRYSTAL GARDEN MONTESSORI
FACILITY NUMBER: 013422452
VISIT DATE: 06/15/2022
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Center Director 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.

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/inspection-process.

There were no deficiencies found during today’s inspection. This report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Center Director, Hua-Hsin (Cynthia) Wan.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC809 (FAS) - (06/04)
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