Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004107
Report Date: 02/09/2018
Date Signed 02/09/2018 03:44:24 PM

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:HIGHLAND MONTESSORI SCHOOLFACILITY NUMBER:
414004107
ADMINISTRATOR:ALISON OTTENWELLERFACILITY TYPE:
850
ADDRESS:614 HIGHLAND AVENUETELEPHONE:
(650) 347-6450
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:20CENSUS: 16DATE:
02/09/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Molly WalshTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Kistler met with Molly Walsh for an unannounced annual/random inspection. Present today is 16 children with three fully qualified teachers. Ratios are met on this day. The center operates Monday-Friday from 7:30am to 5:30pm.

LPA and Molly conducted an inspection of the center. There are no pools, spas or other bodies of water on the premises. Per Molly, there are no firearms or weapons at the center. All cleaning supplies and other potentially harmful items are stored inaccessible to the children. Medications are stored out of reach of children. Furniture and other equipment is in good condition, free from loose, sharp or pointed parts. The bathroom is in operating condition. The center provides two snacks, parents bring lunch from home. The snack menu is posted near the front gate of the center. Food preparation area is clean and free from debris. All food provided by the center is stored appropriately. All bins for solid waste are equipped with secure fitting lids. Uncontaminated drinking water is provided to the children from a water cooler.

Outdoor activity space is enclosed with a fence. Play equipment is in good condition and appears to be age appropriate. Areas under high climbing equipment is adequately cushioned with rubber tire shreds.

A random sample of children's files were reviewed and found to be complete including emergency identification information and medical assessments. LPA reviewed supervision requirements on this day.

Staff files were reviewed and found to have documentation of education credits and health screenings.

See next page for continuation..............
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Katie L KistlerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2018
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: HIGHLAND MONTESSORI SCHOOL
FACILITY NUMBER: 414004107
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/12/2018
Section Cited
CCR
101170(e)(2)
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Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance.
-Staff was observed to not be associated to the center
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Center agreed to associate the staff member to the facility.
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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: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Katie L KistlerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2018
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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: HIGHLAND MONTESSORI SCHOOL
FACILITY NUMBER: 414004107
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/09/2018
Section Cited
CCR
101216(f)
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Personnel Requirements. At least one person trained in CPR and Pediatric first aid shall be present when children are at the facility or offsite activities.

-LPA observed that staff CPR certifications are expired.
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Center agreed to obtain certification for EMSA approved CPR and First Aid. Proof to be submitted to the department.
Type B
03/09/2018
Section Cited
CCR
101229.1(a)
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Sign In and Sign Out- In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center.
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Center agreed to request a waiver for electronic sign in/out.
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The center is using an electronic sign in/out system without and approved waiver.
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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: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Katie L KistlerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2018
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: HIGHLAND MONTESSORI SCHOOL
FACILITY NUMBER: 414004107
VISIT DATE: 02/09/2018
NARRATIVE
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

The center is aware that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety Code 1597.662.



LPA reviewed AB 1207 with the Licensee. As of January 1, 2018 all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

A Type “A” violation (see continuation) was issued today. The center was advised to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all Children's files. This report and appeal rights were provided and reviewed with the Molly. Notice of Site Visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Suzanne Roman-ClarkTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Katie L KistlerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2018
LIC809 (FAS) - (06/04)
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