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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211452
Report Date: 09/07/2022
Date Signed: 09/07/2022 03:02:42 PM

Document Has Been Signed on 09/07/2022 03:02 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:GARDEN MONTESSORI SCHOOLFACILITY NUMBER:
070211452
ADMINISTRATOR:COLLEEN WIGGINSFACILITY TYPE:
850
ADDRESS:495 VERONA AVENUETELEPHONE:
(925) 837-2969
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jaye PerryTIME COMPLETED:
03:30 PM
NARRATIVE
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On 9/7/22 at 2:30 PM Licensing Program Analysts (LPAs) Monica Mathur and Michelle Sutton met with Licensee, Jaye Perry to conduct a Case Management inspection for the Lead Testing results at Garden Montessori School.

LPA conducted an inspection and toured the premises with Jaye. It was indicated that there was one outlet that exceeded the Action Level established by the stated for exposure. LPA discussed a Plan of Correction and facility has submitted the documentation for the post-testing requirements. Licensee states the faucet has been replaced, children do not drink out of it and facility does not prepare meals using that faucet. Licensee states re-testing is yet to be done.

The following deficiency is (See LIC 809-D.) cited from the California Code of Regulations, Title 22. A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Jaye Perry.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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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Document Has Been Signed on 09/07/2022 03:02 PM - It Cannot Be Edited


Created By: Monica Mathur On 09/07/2022 at 02:37 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: GARDEN MONTESSORI SCHOOL
FACILITY NUMBER: 070211452

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/07/2022
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds (a)The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by
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Faciilty has replaced the faucet and is scheduled to re-test. .Facility provided all documentation for lead results
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Based on Lead Testing Samples the facility has one water faucet with lead exposure. This is an potential risk to Health and Safety or Personal Rights risk to persons in care
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By 10/7/22 agreed to submit a written plan to ensure children are provided alternative safe drinking water.

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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022


LIC809 (FAS) - (06/04)
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