414005036-9-5-2023-05-CC-CQUO-CVDPZV-20230905114610

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005036
Report Date: 09/05/2023
Date Signed: 09/05/2023 11:46:15 AM

Document Has Been Signed on 09/05/2023 11:46 AM - 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:	MILLBRAE MONTESSORI SCHOOL, INC.		FACILITY NUMBER:	414005036
ADMINISTRATOR:	PERRY, NICHOLLE		FACILITY TYPE:	850
ADDRESS:	477 LINCOLN CIRCLE		TELEPHONE:	(650) 588-2229
CITY:	MILLBRAE	STATE: CA	ZIP CODE:	94030
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/05/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Nicholle Perry		TIME COMPLETED:	12:00 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 September 5, 2023 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo, conducted a scheduled, pre-licensing inspection. LPA met with applicant, Nicholle Perry, and explained the purpose of the inspection. Department received application July 20, 2023. Fire clearance was obtained August 10, 2023. The applicant is requesting for a capacity of 60 preschool children (ages 2.5 years to entry into first grade). Main entrance to program will be located through side gate, through outdoor area, on the Lincoln Circle street side. The preschool program will operate as a Montessori program. The hours of operation will be Monday through Friday 8:00am to 5:00pm. The program will operate at Millbrae Recreation Center in Classroom A, Classroom B and exclusive outdoor area only. The designated director will be Nicholle Perry. The facility was inspected, indoor and outdoors, for health and safety hazards and measured to calculate capacity. Indoors: Program includes 2 classrooms, an exclusive children's restroom, a snack preparation area for staff only, an office and a rest area located in office. Children will have access to the 2 classrooms, exclusive children's restroom and the rest area when needed. The 2 classrooms that will be utilized for the preschool program are Classroom A and Classroom B. Classroom A was measured for 806.02 sq. ft. allowing for a capacity of 23 children. Classroom B was measured for 789.27 sq. ft. allowing for a capacity of 22 children. Total indoor square footage equals 1,595.29 sq. ft. allowing for a total capacity of 45 children. LPA observed classrooms to be well ventilated with appropriate temperature. Classrooms are equipped with furniture, toys and materials that were observed to be age appropriate. Classrooms have a variety of Montessori toys and materials that were in good working condition. Flooring in classrooms were to be clean and include new carpets. Storage for children's personal belongings will be located outside the classrooms, in the outdoor area. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MILLBRAE MONTESSORI SCHOOL, INC.	FACILITY NUMBER: 414005036
	VISIT DATE: 09/05/2023

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

(Continued, Page 2...)
LPA observed electrical outlets in both classrooms to be made inaccessible, with child safety covers. Poisons, cleaning supplies and hazardous materials will be stored in classrooms' high shelves, inaccessible to children. Entire facility includes a fire sprinkler, smoke detector, fire system. Preschool program is equipped with a fully charged fire extinguisher. Both classrooms were observed to be equipped with new first aid kits, and working carbon monoxide detectors. LPA tested carbon monoxide detector located under classroom sinks, which was observed to be working. Applicant also maintains an emergency backpack that will be maintained in the facility.

Medications with children’s individual names and required documentation will be stored in appropriate classrooms' high shelves.

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) tollfree 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, available at: http://www.ada.gov/childqanda.htm.

Program plans to provide napping children with mats that will be stored in office. Children's families are to provide blankets and sheets. Program plans to store children's sheets in children's backpacks so they are not touching each other. Per applicant, blankets and sheets will be sent home weekly or as needed.

Applicant plans for isolation area to be the rest area in the office. Program's discipline policy was discussed. Applicant plans to manage children with difficult behavior by talking to, consoling and redirecting children.

Program has exclusive use of a children's bathroom that is shared between both classrooms. Both classrooms include 3 accessible sinks (6 total) that do not provide water that is warmer than 120 degrees Fahrenheit. Shared bathroom includes 4 toilets that were observed to be in proper working condition. Bathroom includes individual stalls. Applicant is aware children using the restroom must always be supervised. Total allowable capacity for sinks is 90 children. Total allowable capacity for toilets is 60 children.

Program plans to provide a food service that includes morning and afternoon snack only. Applicant plans for children's families to provide lunch for their children. Program does not plan to refrigerate or reheat children's lunches. Program's dry snacks will be prepared in snack preparation area located in between classrooms. Dry snacks will be stored in a separate cabinet from cleaning solutions and supplies to avoid contamination. Water is made accessible through portable, filtered water stations located in both classrooms.
(Continued, Page 3...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC809 (FAS) - (06/04)

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MILLBRAE MONTESSORI SCHOOL, INC.	FACILITY NUMBER: 414005036
	VISIT DATE: 09/05/2023

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

(Continued, Page 3...)
Outdoor: The outdoor area is located directly outside of both classrooms. Outdoor area is entirely fenced and enclosed. There is natural shade provided from surrounding building. Total outdoor area measures for 2,623 sq. ft. allowing for a capacity of 34 children. Outdoor area is equipped with a variety of outdoor toys and materials that were observed to be in good working condition. There is a play structure that was observed to have resilient padding underneath. Applicant is aware children must always be supervised going to and from the outdoor area. Water is made available both indoors and outdoors through the portable water stations that will be refilled from sink in food preparation area.

The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Per applicant, Millbrae Recreation Center building was built after 2010. Proof of building being built after 2010 will be provided to LPA. LPA advised applicant to review PIN 21-21-CCP.

LPA reminded applicant emergency disaster drills must be documented when conducted. Applicant plans for children to be signed into and out of program by children's authorized representative's written signatures.

LPA reviewed with applicant, the LIC311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant was informed of the MyChildCarePlan.org site, 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.
(Continue Report on Page 4...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MILLBRAE MONTESSORI SCHOOL, INC.	FACILITY NUMBER: 414005036
	VISIT DATE: 09/05/2023

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

(Continued, Page 4...)
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.

During visit, LPA was provided copies of resubmitted documents indicated on Notice of Incomplete Application (LIC184C) from applicant.

Based on square footage, maximum number program can be licensed for is 45 preschool children.

Prior to recommended licensure, following must be completed:
-LPA's review and approval of documents resubmitted.
-Sound alarm system on both gates in outdoor area.
-Posting of licensing documentation.
-Request for Outdoor Waiver.

Exit interview conducted and report was reviewed with the applicant, Nicholle Perry.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4