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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005036
Report Date: 10/30/2024
Date Signed: 10/30/2024 11:57:47 AM

Document Has Been Signed on 10/30/2024 11:57 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/
DIRECTOR:		PERRY, NICHOLLEFACILITY TYPE:
850
ADDRESS:477 LINCOLN CIRCLETELEPHONE:
(650) 231-8181
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY: 45TOTAL ENROLLED CHILDREN: 40CENSUS: 34DATE:
10/30/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Nicholle PerryTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 10/30/2024, at approximately 8:30 AM, Licensing Program Analyst (LPA) Zeynep Basak conducted an unannounced annual inspection, met with the designee Renee Sapian, and the director, Nicholle Perry arrived at 8:56 a.m. The purpose of the inspection was explained to the director. The facility operates in Millbrae Recreation Center Monday to Friday from 8:00 am to 5:00 pm.

Upon entry, LPA observed 4 staff members. 34 preschool children were present during the inspection. The facility operates within its capacity and complies with the staff/child ratio on this day.

LPA inspected 2 daycare rooms and the outdoor space with the director. LPA observed that the facility has 2 combined smoke and carbon monoxide detectors in each room and a fully charged fire extinguisher model 2A10BC located in the food preparation area.

LPA observed the facility has a fully stocked first aid kit and a functioning telephone. Per director there is no child has allergy in the center.

LPA observed the facility has age-appropriate furniture, toys, and educational materials in each classroom. The facility floor and rugs are in good condition and free of any hazards.

LPA observed all cleaning solutions and other chemicals dangerous to the children are properly stored and made inaccessible to the children.
LPA observed there are cabbies, 4 toilets in the children's bathroom, and 3 sinks in the classroom next to the bathroom door. All toilets and sinks were clean, sanitary, and in working condition and the water temperature was proper.
See page 2.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2024
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 3
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: 10/30/2024
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LPA observed the facility has enough sleeping cots/mats. Per the director, individual blankets and sheets were brought from home and every week sent home to be washed.

According to the director, the facility provides morning and afternoon snacks besides drinking water, and lunches are brought from home.

LPA observed outdoor areas with the director and found there is a variety of play and sports equipment available for the children. All play structures are in good repair and the playground is free from health and safety hazards.

Per the director, the facility is using paper for the sign-in/out sheet and LPA observed all authorized representatives have signed for today.

LPA observed the facility has a license, and all other required documents are posted and visible to the public. The facility has an emergency drill log, and the last drill was conducted on September 24, 2024.

The LPA reviewed the facility records, 6 children's files, and 5 staff files. LPA found all required documents in the children's file including immunization records, LIC 700, and Personal-Parents Rights. LPA also observed all necessary documents available in the staff file including CPR and Mandated Reporter Training.



The Director 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.
See page 3.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: MILLBRAE MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 414005036
VISIT DATE: 10/30/2024
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The facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

The director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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.
The director was advised that for any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

The report was reviewed and signed by the director, Nicholle Perry. The Notice of Site Visit will be provided to be posted for 30 days.

An exit interview was conducted with the director, Nicholle Perry.
SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Zeynep Basak
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
LIC809 (FAS) - (06/04)
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