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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004588
Report Date: 07/19/2022
Date Signed: 07/19/2022 02:04:11 PM

Document Has Been Signed on 07/19/2022 02:04 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MISSION MONTESSORI (INF)FACILITY NUMBER:
384004588
ADMINISTRATOR:DOMINGO, ROCHELLEFACILITY TYPE:
830
ADDRESS:50 FELL STREETTELEPHONE:
(415) 805-8315
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: DATE:
07/19/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Rochelle DomingoTIME COMPLETED:
12:09 PM
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On July 19, 2022 at 9:00 AM, Licensing Program Analysts (LPA) Sheran Lo met with Director Rochelle Domingo today for a pre-licensing inspection. This inspection of facility is a change of ownership application. The applicant is requesting 29 children (0 to 2 years old with 18 spaces for toddlers 18 months to 36 months). The facility will operate Monday - Friday; 8:00 AM to 5:15 PM. The designated director is Rochelle Domingo. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity.

Indoor: There are three classrooms that will be used for the program and the following square footage was calculated for each room: Room 101- 510 sq ft., Room 102-728 sq ft., and Room 103- 504 sq ft. Total useable indoor square footage is 1742 sq ft divided by 35 sq ft equals 49 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There is storage space for children's personal belongings and floor beds to be utilized for napping children. Facility will provide beddings to be laundered on site. Floor beds will be cleaned at least weekly or more often if needed. Children will be signed in and out with an electronic system.. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, separate kitchen area where snack food is stored, garbage cans with tight-fitting lids, first aid and emergency supplies. The facility is adequately ventilated and free of insects and bugs. Windows are high up inaccessible to children. The program does not provided meals for infants. Snack foods will be stored in the classroom refrigerator separately from any cleaning products or other hazards. Medications will be stored in the health office area inaccessible to the children; there is a refrigerator located in this area for refrigerated medications.
There are _2 toilets (30 capacity) and 3 sinks (45 capacity) accessible for children's use. Bathrooms are located either inside the classrooms or in the hallway. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MISSION MONTESSORI (INF)
FACILITY NUMBER: 384004588
VISIT DATE: 07/19/2022
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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

LPA reviewed with director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA recommends Licensure when our office receives Fire Clearance.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022
LIC809 (FAS) - (06/04)
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