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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710435
Report Date: 02/19/2020
Date Signed: 02/19/2020 10:40:11 AM

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:MONTAGUE DISTRICT/STATE PRESCHOOLFACILITY NUMBER:
430710435
ADMINISTRATOR:GINA PEREZFACILITY TYPE:
850
ADDRESS:750 LAURIE AVENUETELEPHONE:
(408) 423-1931
CITY:SANTA CLARASTATE: CAZIP CODE:
95054
CAPACITY:120CENSUS: DATE:
02/19/2020
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Gina Perez and Anita KinneyTIME COMPLETED:
10:45 AM
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On this day Licensing Program Manager (LPM) Segura, Mary and Licensing Program Analyst (LPA) Almaraz, Araceli met with Director Perez, GIna and Program Specialist (PS) Kinney, Anita to clarify information regarding this facility and the LIC 999. This facility has requested a capacity decrease to 72 children. LPM reviewed the current floor plan of the facility for the capacity decrease request. .

The following was discussed: LPM asked if room 28 and 14 were forfeited. Director states they still operate room 28 and room 14 was forfeited as well as room 12. Criteria for capacity was reviewed. Director Perez and PS Kinney, state School district took over rooms 14 and 12 in 08/2019. Rooms 26, 27 and 28 still in use. LPM provided a copy of LIC 999 and LIC 200a to be updated. The number of available toilets and sinks discussed. Gina Perez states there is waiver on file for shared lavatories (sinks and toilets). Rooms 26 and 27 in use from 8:30 AM to 11:30 AM not used after these hours. Rooms 26, 27 have one sink each, 28 has two sinks. The lavatories have the following: 3 toilets , 2 sinks in girls lavatory , 2 toilets and a urinal and 2 sinks n boys lavatory. Isolation lavatory area next to boys lavatory, generally used for special education. Staff has separate lavatory. Sick children isolated in room 28, Director Perez's office area. YMCA uses cafeteria lavatory. On occasion the YMCA children use the lavatory and the end of the corridor next to room 22. Director states there is no commingling in the lavatories. Room 28 is district preschool, Rooms 26 and 27 are Title 5 state preschool. here are currently a total of 67 preschool children enrolled in all classrooms, including 24 children enrolled in state preschool.

LPM requested an updated LIC 999 which includes play ground and lavatories to be used indicated including all toilets, sinks and urinals and which area available to children only and which will be used by staff/ sick child. Also include the distance from room 28 to lavatories. An updated fire clearance will be sent, measurements taken again by licensing.. A new LIC 200a shall be submitted with # 6, # 11, # 12 and #15 updated to include missing information, applicant is i Santa Clara Unified School district. LPM has asked that updated. LIC 200a and LIC 999 be returned on or before 02/26/2020.
A copy of this report was given.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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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