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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413022
Report Date: 11/08/2021
Date Signed: 11/08/2021 02:20:02 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:DAY STAR MONTESSORI SCHOOL, INC.FACILITY NUMBER:
434413022
ADMINISTRATOR:REGINE MONINA GANGOSOFACILITY TYPE:
850
ADDRESS:215 DEMPSEY ROADTELEPHONE:
(408) 263-1618
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:150CENSUS: 85DATE:
11/08/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Regine Monina GangosoTIME COMPLETED:
02:30 PM
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On Monday, November 08, 2021 at 10:14 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Case Management Visit - Covid 19. LPA met with the Director Regine Monina Gangoso and explained the nature of site visit. Present on this visit were 19 staff and 85 preschool children. The facility operates from Monday to Friday 8:30 am to 6:00 pm.

Director submitted LIC 624 dated 10/18/2021 and 10/20/2021 to the Oakland South East Regional Office via email. LPA completed the COVID-19 Initial Positive Survey. The facility was in compliance of the Reporting Requirement Regulation.

No regulatory violation was observed at the time of the visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Regine Monina Gangoso.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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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