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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380505549
Report Date: 03/06/2024
Date Signed: 03/06/2024 10:44:41 AM

Document Has Been Signed on 03/06/2024 10:44 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:ALEXANDER, BARBARA - BELVEDERE MONTESSORIFACILITY NUMBER:
380505549
ADMINISTRATOR:ALEXANDER, BARBARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 564-3173
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94117
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
03/06/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee, Barbara AlexanderTIME COMPLETED:
11:00 AM
NARRATIVE
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On 3/6/2024, at approximately 8:45AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Barbara Alexander. LPA explained the purpose of the visit. Present during the visit were the Licensee, two helpers, and six preschool age children. The facility is in compliance with capacity requirements on this day. The facility’s operating hours are from 9:00AM to 5:30PM.

Daycare Areas: Art Area, Classroom, Bathroom, and Backyard.
Off-limits Areas: Garage and entire upper level.

LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. There are age-appropriate toys and learning materials present in the Art Area and the Classroom. There is a fully charged fire extinguisher present in the Art Area. There are smoke and carbon monoxide detectors present in the home. There are mats available for children to use for napping as needed. Cubbies are available for each child to use. Children bring lunch from home and the facility provides snacks for them. There are two pet cats in the home. Per Licensee, there are no firearms or weapons in the home.

LPA observed the Backyard to be free of debris and other loose material. The Backyard is enclosed by a fence that is at least five feet high. The Backyard is used for snack time and for gardening. There are no pools or other bodies of water present in the facility.

LPA reviewed personnel records and six children’s files. Licensee’s Mandated Reporter Training expires 3/2025. LPA observed that Licensee’s First Aid/CPR certification is not from an EMSA-certified vendor. LPA advised Licensee that EMSA First Aid/CPR certification includes an in-person skills test. Licensee understood. See LIC9102-TV for technical violation issued regarding First Aid/CPR training.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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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: ALEXANDER, BARBARA - BELVEDERE MONTESSORI
FACILITY NUMBER: 380505549
VISIT DATE: 03/06/2024
NARRATIVE
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LPA observed all children’s files to be complete. Included in the files were Emergency Identification and Information (LIC700) and Consent for Emergency Medical Treatment (LIC627). LPA observed required postings to be accessible and visible immediately upon entry to the facility.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
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: ALEXANDER, BARBARA - BELVEDERE MONTESSORI
FACILITY NUMBER: 380505549
VISIT DATE: 03/06/2024
NARRATIVE
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Licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See LIC9102-TV for technical violation issued during today’s visit on 3/6/2024.
No deficiencies were cited during today's visit on 3/6/2024.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Barbara Alexander.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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