<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422452
Report Date: 11/05/2025
Date Signed: 11/05/2025 04:42:29 PM

Document Has Been Signed on 11/05/2025 04:42 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:CRYSTAL GARDEN MONTESSORIFACILITY NUMBER:
013422452
ADMINISTRATOR/
DIRECTOR:
HUA-HSIN(CYNTHIA),WANFACILITY TYPE:
850
ADDRESS:37531 FREMONT BLVD.TELEPHONE:
(510) 792-8415
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 1DATE:
11/05/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:11 PM
MET WITH:Hua-Hsin (Cynthia) WanTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On November 5, 2025, at 2:11pm, Licensing Program Analyst (LPA) Randy Miranda arrived unannounced for an annual inspection for compliance to Health and Safety. LPA was greeted by Center Director Hua-Hsin (Cynthia) Wan and was granted entry into the facility. Present during the inspection were the center director, center director’s spouse (teacher’s aide), and one (1) preschool children in care. The hours of operation are Monday – Friday, 8:00am to 6:00pm.

The facility is a converted older home adapted for use as a child daycare center. It is equipped with heating and ventilation systems to ensure comfort. The layout includes six rooms: two playrooms, an arts and crafts room, a snack room, a group music room, and a small office. Additionally, there is a designated food preparation area that is off-limits to children. LPA observed a barricaded fireplace located in the playroom near the main entrance, which has been made inaccessible to children in care.

The outdoor area includes a pull-through driveway designated for child drop-off and pick-up. Swinging gates are closed and locked when children enter the gated playground located at the rear of the facility on the west side. The playground is enclosed by a 6-foot privacy fence. All play equipment is in safe condition and free of sharp, loose, or pointed components. There is no high climbing equipment, and the play surface is concrete. Shade is available throughout the play areas, and staff maintain supervision. Children bring bottled water from home, and additional water is accessible both indoors and outdoors.

The children's bathroom contains two toilets separated by a wall, two sinks, and a changing table located outside the bathroom. The sinks are equipped with functioning cold water taps and appropriate handwashing materials. A touch-free trash can with a lid is available, along with an adequate supply of paper towels, soap, and diapering materials. All toilets, handwashing stations, and cleaning areas are maintained in safe and sanitary operating condition. Staff bathrooms are separate and located near the kitchen area.

NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Randy Miranda
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 4
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: CRYSTAL GARDEN MONTESSORI
FACILITY NUMBER: 013422452
VISIT DATE: 11/05/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The facility is equipped with a fully charged 2A10BC fire extinguisher in the toddler room and a 3A40BC fire extinguisher in the kitchen area. Functional carbon monoxide detectors are installed and have been tested to ensure proper operation. Disaster drills are conducted monthly; the most recent drill took place on 10/20/25.

The sign-in/out sheets were reviewed, and all children present were properly signed in. The school provides lunches and snacks, with a weekly menu posted for reference. The food preparation area in the kitchen is off-limits to children; no sharp knives were observed in the kitchen during today's visit. Cleaning chemicals and other cleaning agents are stored securely out of children's reach.

The facility is clean and well organized, with age-appropriate furnishings and equipment in good repair. Surfaces, including floors and countertops, are clean and free of toxic substances. There is an ample supply of age-appropriate toys, all of which appear safe and in good condition. No bodies of water are accessible to children in care. Classrooms are equipped with touchless trash cans featuring tight-fitting lids for the disposal of solid waste. No hazardous items or toxins were observed to be accessible to children during today's visit. No firearms or weapons are kept on the premises. All documents required to be publicly posted were present. Lead testing was completed on December 18, 2021, and the results are posted near the facility license.

Staff files were reviewed and found to be complete and in good order. The Center Director’s CPR/First Aid certification expires on 03/15/27, and the Mandated Reporter certificate expires on 04/02/26. The Teacher’s Aide holds a CPR/First Aid certification valid through 03/15/27, and a Mandated Reporter certificate expiring on 04/02/26.

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

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/.

NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Randy Miranda
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: CRYSTAL GARDEN MONTESSORI
FACILITY NUMBER: 013422452
VISIT DATE: 11/05/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Site supervisor 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.

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. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Lead testing is complete and documented.

Effective August 1, 2003, California Law requires Child Care Licensees 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 to the regional office by phone and the written report, LIC 624, within 7 business days. Site Director 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.

To improve the quality and value of the 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 issued 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. Appeal Rights provided.

Exit interview conducted and report was reviewed with the Center Director, Hua-Hsin (Cynthia) Wan.
NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Randy Miranda
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4