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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004588
Report Date: 10/25/2024
Date Signed: 10/25/2024 04:29:21 PM

Document Has Been Signed on 10/25/2024 04:29 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MISSION MONTESSORI (INF)FACILITY NUMBER:
384004588
ADMINISTRATOR/
DIRECTOR:		DOMINGO, ROCHELLEFACILITY TYPE:
830
ADDRESS:50 FELL STREETTELEPHONE:
(415) 805-8315
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94102
CAPACITY: 54TOTAL ENROLLED CHILDREN: 97CENSUS: 75DATE:
10/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:27 PM
MET WITH:LaRhonda MartinTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On 10/25/2024 Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced case management inspection and met with executive director LaRhonda Martin. The purpose of the inspection was explained to the director by the LPA. LPA observed the director, 14 staff, and 75 children (14 infants, 18 toddlers, and 43 preschool children) present during the visit.
LPA verified the criminal background clearance of the staff on the Guardian website.

The case management was about a staff member whose breath smelled alcohol and the incident report was submitted by executive director, Dr. LaRhonda Martin on 10/21/2024.

Per the director, the staff came to the center 3 times in a similar situation, and they sent him home and then decided to terminate the staff on 10/18/2024.

A Type A violation for Conduct Inimical in accordance with Health and Safety Code Title 22, Division 12
Chapter 1 101206(1)(c) will be cited on 809D today.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from a parent. The licensee was provided with a copy of the parent's Acknowledgement of Receipt of the Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

The exit interview was conducted, and the report was reviewed with the executive director, Dr. LaRhonda Martin

Appeal Rights were provided. Notice of Site Visit was provided to be posted for 30 days.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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 10/25/2024 04:29 PM - It Cannot Be Edited


Created By: Zeynep Basak On 10/25/2024 at 03:47 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISSION MONTESSORI (INF)
FACILITY NUMBER: 384004588

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2024
Section Cited
HSC
101206(1)(c)

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101206
Revocation or Suspension of License (1) Health and Safety Code Section 1596.885 provides:(c)Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.

This requirement is not met by:
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The employee is terminated on 10/18/2024
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Based on the record review, and the interview, the employee came to the center with the smell of alcohol in his breath several times which poses an immediate health, safety, or personal rights risk to the children in care.
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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:Daniel J Oquendo
LICENSING EVALUATOR NAME:Zeynep Basak
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


LIC809 (FAS) - (06/04)
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