384004040-7-30-2021-05-CC-HKAR-C5EQN6-20210730121839

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004040
Report Date: 07/30/2021
Date Signed: 07/30/2021 12:19:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	MISSION MONTESSORI PRESCHOOL- INFANT		FACILITY NUMBER:	384004040
ADMINISTRATOR:	SCHACHT, PARI		FACILITY TYPE:	830
ADDRESS:	50 FELL STREET		TELEPHONE:	(415) 805-8315
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94102
CAPACITY:	29	CENSUS: 16	DATE:	07/30/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Rochelle Domingo		TIME COMPLETED:	12:18 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	On July 30, 2021, at 10:30AM, Licensing Program Analysts (LPAs) Kaur and Van conducted announced case management and met with Head of school, Rochelle Domingo. The purpose of the inspection was explained and granted entry to the facility. The Department received an application from the Licensee requesting to add a toddler option component to the existing license and increase capacity on 06/14/2021. Due to the age range change on the license, a fire safety inspection is required, and LPAs had made a Fire clearance request from the SF Fire Department on 06/14/21. Currently, the infant program is operating in rooms #101, #102, and #103. There were no changes made to the previously licensed indoor spaces or outdoor play spaces. During the inspection, LPAs remeasure all three classrooms for accuracy. As the center is requesting to add one additional child to its license, of which the capacity will be 30. Room #101 measures 453, room #102- 769, and room #103 -633. The total square footages for all three rooms are 1855, allowing for 53 children. The Licensee is requesting to designate room #101 as the toddler option program room with a maximum size of 12 toddler option children. The toddler room has their own bathroom and changing table. Licensee acknowledges that infant and toddler option children cannot commingle, and neither indoor nor outdoor, the group must be kept physically separate, Continue on next page....

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: MISSION MONTESSORI PRESCHOOL- INFANT	FACILITY NUMBER: 384004040
	VISIT DATE: 07/30/2021

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The room # 101 can accommodate at least 12 children and has toys and equipment were observed to be age-appropriate. The Licensee has submitted an updated application (LIC 200A), an updated Personnel Report (LIC 500), and a Facility Sketch (LIC 999), as well as an amended updated Parent Handbook and Admission Agreement. Licensee understands that the age range for the toddler option is 18 months to 36 months and that authorized representatives must obtain written permission from the child's authorized representative. LPAs discussed with the Director the ratio and staffing for the toddler option.

LPA will recommend licensure of the infant program to include a toddler option component once Fire Clearance is received. The total licensed capacity of 30 and the 30 total children no more than 12 can be toddler option aged.

The report was reviewed and signed by Rochelle Domingo Today's report, 7/30/2021, and notice of site visit will be emailed to the Head of school at by the close of business on 7/30/21. Confirmation of receipt is required.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Harsimran Kaur	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC809 (FAS) - (06/04)

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