354415951-10-26-2020-07-CC-DMAC-BURV48-20201026160555

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354415951
Report Date: 10/08/2020
Date Signed: 10/26/2020 04:06:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	HOLLISTER MONTESSORI SCHOOL		FACILITY NUMBER:	354415951
ADMINISTRATOR:	DEBORAH LYNN PARGA		FACILITY TYPE:	850
ADDRESS:	2300 SOUTHSIDE ROAD		TELEPHONE:	(408) 408-2930
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY:	30	CENSUS: 0	DATE:	10/08/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Deborah Lynn Parga		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Dung Mac conducted a Tele-Prelicensing inspection via video conference call with Deborah Parga, the Applicant Representative. The Applicant is applying for a Preschool License to serve a maximum of 30 children ages 2.5 years to entry to first grade. Fire Clearance has been granted on 8/13/2020. The Preschool Center will operate Monday through Friday from 07:30AM to 04:30PM. The facility was inspected inside and outside via video conference call (FaceTime). The Facility has four classrooms indoors (Classrooms 1, 2, 3, and 4) and one outdoor play space. The measurements of the indoor/outdoor areas were taken by Deborah Parga and her assistants as LPA observed the measuring process and provided directions via FaceTime (video call). Indoor measurements are as follows: Classroom 1: 41.000 x 27.833 sq. ft (no encumbered space) = 1,141.153 Classroom 2: 36.333 x 13.000 sq .ft (no encumbered space) = 472.329 Classroom 3: 36.583 x 25.250 sq. ft (no encumbered space) = 923.720 Classroom 4: 19.250 x 10.000 sq. ft (no encumbered space) = 192.500 TOTAL INDOOR SPACE = 2,729.702 sq ft divided by 35 = 77 preschool children There are 35 tables and 36 chairs for children. There are cubbies for children to store their belongings. The facility has cots and mats for children to use for napping. There are adequate equipment, supplies, and toys for the preschool children in each classroom. LPA observed all classrooms are clean and safe for children. Children will bring their own water bottles. Facility will provide drinking water indoors/outdoors via a jug of water and disposable cups. LPA observed a solid waste container with a tight-fitting lid in each classroom. Cleaning supplies are stored in a locked cabinet in the back room. Facility has smoke/carbon monoxide detectors. First aid supplies and medications are stored inaccessible to the children. Report continued on Page #2

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HOLLISTER MONTESSORI SCHOOL	FACILITY NUMBER: 354415951
	VISIT DATE: 10/08/2020

NARRATIVE

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Report continue from Page #1

There are 2 toilets (30) and 2 sinks (30) inside the facility for children to use. Bathroom was observed to be sanitary and functioning. The Applicant states that the sinks used by children only have cold running water. Facility has a staff bathroom which is located in the courtyard. Children who become ill will use the staff bathroom and will be isolated in the director's office with isolation equipment. The Applicant states that facility will not provide transportation.

The food preparation area (kitchen) has sink, refrigerator, microwave, stove, dishwasher, storage space for food, and hot and cold running water. Children will bring their own snacks and lunch. Disposable utensils and plates will be utilized by the facility.

OUTDOOR MEASUREMENTS:

Playground: (173.000 x 176.000 = 30,448.000) - (8.000 x 6.000 encumbered space)
= 30,400.000

Total outdoor space = 30,400.000 sq ft divided by 75 = 405 preschool children.

LPA observed that there is adequate fencing surrounding the playground. Areas around and under the play structure have wood chips used as material that absorbs fall. Playground also has bike path, deck and bridge. LPA observed a locked gate near a raised deck and a locked shed. Shade is provided by trees and umbrellas. LPA did not observe any bodies of water during today's inspection.

Facility plans to provide Incidental Medical Services (IMS). IMS plan has been submitted to the Department. LPA had also provided to facility 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.

Report continued on Page #3

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HOLLISTER MONTESSORI SCHOOL	FACILITY NUMBER: 354415951
	VISIT DATE: 10/08/2020

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Deborah Parga, the Applicant Representative/Site Director, has obtained a Clearance for Criminal Background and Child Abuse Index Checks. She also meets the education and experience qualification requirement and had completed 8 hours training on Preventive Health Practices which included Child Care Nutrition. Deborah will need to renew Pediatric CPR/1st Aid and enroll in Lead Poisoning Prevention training. Deborah has proof of immunity against Measles and Pertussis and Health Screening with Tuberculosis clearance. Her Mandated Reporter Training for Child Care Provider Certification expires 9/8/2021.

LPA reminded Applicant Representative of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the facility, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.

The Applicant was informed that due to the current Covid-19 pandemic and "Shelter In Place" Order, the Facility Evaluation Report will be emailed to the Applicant (email: dparga@hollistermontessori.com) with "Read Receipt" notification. The Applicant understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit interview and advised the Applicant that a 90 day "provisional" license for 30 Preschool children will be submitted for the final stage of review by Licensing Management upon the receipt of the following:
1) Proof of registration for First Aid/CPR and Lead Poisoning Prevention training.
2) Updated Designation of Facility Responsibility (LIC 308).
3) A copy of Certificate for Application Orientation.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2020

LIC809 (FAS) - (06/04)

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