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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422410
Report Date: 02/21/2020
Date Signed: 02/21/2020 12:50:52 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: 225DATE:
02/21/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jaskiran GrewalTIME COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Melanie Otsuji and Jonathan Williams arrived to the facility unannounced for an unrelated matter and observed a licensing violation. Present during today's visit were 29 staff members, 225 preschool aged children. LPAs met with Licensee's Jaskiran & Harpreet Grewal.

On today's date, 2/21/2020 at around 10:30AM, LPA's conducted a census of the facility. LPA's along with Director Shirley Reyes counted 225 preschool aged children present. Per fire clearance and capacity of license, this facility is only able to have 214 children present.

See 809-D for the TYPE A deficiency that was cited on today's visit. An immediate civil penalty was issued on today's date.

An exit interview was conducted. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. LIC9224 provided to Licensee. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians newly enrolled children at the facility during the next 12 months. Facility is to obtain a signed copy of LIC9224 for each child and records to be kept on file.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/24/2020
Section Cited

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All child care centers shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not being met as evidence by: On today's date, 2/21/2020, LPA's census was 225 for the facility. The facility's fire clearance
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and capacity is 214. This poses an immediate risk to the health and safety to the children in care.
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**Immediate civil penalty issued on today's date.**

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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: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2020
LIC809 (FAS) - (06/04)
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