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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422410
Report Date: 03/05/2020
Date Signed: 03/05/2020 01:03:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LEARN AND PLAY MONTESSORI IRVINGTON, INC.FACILITY NUMBER:
013422410
ADMINISTRATOR:GREWAL, JASKIRANFACILITY TYPE:
850
ADDRESS:40803 FREMONT BLVD.TELEPHONE:
(510) 573-0071
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:214CENSUS: 198DATE:
03/05/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Shirley ReyesTIME COMPLETED:
01:06 PM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct a Plan of Correction (POC) inspection. LPA met with Director Shirley Reyes. Present during today's visit are 27 staff members and 198 preschool aged children.

LPA conducted a census of the facility at 12:05PM. The following corrections have been made:

1) 101171(a) Facility is now within the maximum capacity allowed by the Fire Clearance and License.

There are no deficiencies cited on today's date 3/5/2020. Copy of Cleared POC's letter provided.

An exit interview was conducted. This report must be available for review for 3 years. A notice of site visit was posted. Notice of site visit must remain posted for 30 days.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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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