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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408293
Report Date: 06/16/2021
Date Signed: 06/16/2021 03:49:12 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:EMPIRE MONTESSORI PRESCHOOLFACILITY NUMBER:
073408293
ADMINISTRATOR:YANG, SHIMEIFACILITY TYPE:
850
ADDRESS:409 BOYD RD.TELEPHONE:
(408) 242-8898
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:72CENSUS: 3DATE:
06/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Li LinTIME COMPLETED:
04:00 PM
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On 6/16/21 at 2:15pm, Licensing Program Manager (LPM) Loretta Dyson arrived at the facility for an unannounced case management inspection. LPM met with the director, Li Lin. There was one additional staff member and 3 children also present. An increase of capacity application was received and LPM arrived to complete the inspection. The facility will operate Monday-Friday 8am- 5pm, in 3 classrooms. A tour of the facility was completed to conduct a health and safety inspection. The director stated that there have been no changes to the facility, which would cause a change to the physical plant requirements or measurements previously completed. The previous measurements completed on 3/5/20 are as follows:
INDOORS: 2,769.78 square feet = 79 children
OUTDOORS: 5,457.81 square feet = 72 children
A fire clearance, for a capacity of 79 preschoolers, was received from the Contra Costa Fire Protection Department on 6/11/20.

The facility was closed due to the COVID-19 pandemic and LPM is now able to complete the application process today. LPM did not observe any defects or dangerous conditions, including hazardous items, toxins, medications or bodies of water accessible to children today. The facility provides snacks for children and water is available with pitchers and water bottles or disposable cups.

The facility has an approved waiver for the playground, and is reminded not to have more than 72 children outdoors at one time. LPM reminded the director to follow regulations and guidelines regarding criminal record clearance, unusual incident/injury reporting, ratio and supervision.

The facility will be licensed for a total capacity of 79, effective today 6/16/21. There are no deficiencies being cited today. This report will remain on file for 3 years. A Notice of Site Visit was provided and the director was reminded to have it posted for 30 days. An exit interview was conducted.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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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