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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004107
Report Date: 09/26/2019
Date Signed: 09/26/2019 05:22:13 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:HIGHLAND MONTESSORI SCHOOLFACILITY NUMBER:
414004107
ADMINISTRATOR:WALSH, MOLLYFACILITY TYPE:
850
ADDRESS:614 HIGHLAND AVENUETELEPHONE:
(650) 347-6450
CITY:SAN MATEOSTATE: CAZIP CODE:
94401
CAPACITY:20CENSUS: 17DATE:
09/26/2019
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Molly WalshTIME COMPLETED:
05:40 PM
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Licensing Program Analyst (LPA) Marie Rodriguez made an announced Case Management inspection in response to an application received from Licensee for a capacity increase. Licensee is requesting to increase the capacity from 20 children to 26 children, all ambulatory. During today's inspection, LPA toured the facility building and grounds with Site Director Molly Walsh.

Indoor Space: 1025.757 square feet divided by 35 equals 32 children

Outdoor Space: 3600.493 square feet divided by 75 equals 48 children

Sinks/Toilets: There are two toilets and two sinks available for children's use. Based on this number, the maximum capacity allowed is 30 children.

Fire Alarm System was installed and approved by fire inspector on July 12, 2019.

Capacity increase to 26 children will only be approved once fire clearance inspection has been granted by fire inspector.

Report was reviewed and discussed with Site Director Molly Walsh. A copy of report was provided.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) -26-8800
LICENSING EVALUATOR NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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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