434414879-11-14-2019-07-CC-SRED-BHWQPC-20191114112031

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414879
Report Date: 11/14/2019
Date Signed: 11/14/2019 11:20:42 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:	CABRILLO MONTESSORI SCHOOL INC		FACILITY NUMBER:	434414879
ADMINISTRATOR:	MILINH VILLANUEVA		FACILITY TYPE:	850
ADDRESS:	2495 CABRILLO AVENUE		TELEPHONE:	(408) 418-3568
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	89	CENSUS: 71	DATE:	11/14/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Milinh Villanueva		TIME COMPLETED:	11:30 AM

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), Shannel Reed, met with Director, Milinh Villanueva, for an unannounced a case management inspection in the Preschool Program. LPA toured the indoor outdoor of the facility today. LPA observed 71 children with seven (7) Teachers and two (2) Aides. During LPA’s previous annual inspection, LPA was informed of Room name changes and adjustments to the rooms being used for the daycare program. Licensing was not advised of the structural change as required by Licensing regulations. LPA discussed the requirements with the Director, and informed her that whenever any structural changes are made to the facility, CCL must be notified in advance. LPA requested an updated facility sketch and ordered a Fire Clearance from Santa Clara City Fire Department on 09/27/19. The Fire Clearance was granted on 10/08/19. The facility previous measurements of rooms on 08/24/16 are: Studio: 24.667 x 9.917 = 244.622 Pinnacles: 35.500 x 20.917 = 742.553 Denali: 31.417 x 33.917 = 1,065.570 Yellowstone: 39.750 x 31.417 = 1,248.825 TOTAL INDOOR SPACE: 3,301.570 sq. ft. divided by 35 = 94 preschool children. However, the facility has removed the Studio from rooms used for daycare space and has added the Pinnacles Room, formerly the staff kitchen. The updated measurements for the facility are as follows: (measured today, 11/14/19) Sequoia: 20.917 x 23.917 = 500.271889- 0 encumbered space = 500.272 Sequoia cont’d: 28.167 x 11.667 = 328.624389- 0 encumbered space = 328.624 Denali: 33.75 x 30.833 = 1040.61375- 0 encumbered space= 1040.614 Yellowstone: 30.833 x 37.667 = 1161.386611 - 0 encumbered space = 1161.387 Pinnacles: 22.167 x 27.75 = 615.13425 - 0 encumbered space= 615.134 REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 11/14/2019):

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

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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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: CABRILLO MONTESSORI SCHOOL INC	FACILITY NUMBER: 434414879
	VISIT DATE: 11/14/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 11/14/2019):
Pinnacles cont’d: 19.25 x 14.25 = 274.3125 - 0 encumbered space = 274.313
Pinnacles cont’d: 21 x 14.167 = 297.5070 - encumbered space = 297.507
TOTAL INDOOR CAPACITY SPACE: 3717.579 Divided by 35 (SQ. FEET) = 106.217

There is 6 toilets (90), 1 urinal (15), and 6 sinks (90) available for the preschool children. There is no hot water available in the children's sink. LPA observed soap dispensers and disposable paper towels in the preschool bathrooms. Staff have one separate bathroom, located in the Church. The bathroom to be utilized by sick children if necessary is located directly outside of the Sequoia classroom. Sick children will be isolated near the director's office area and isolation equipment is provided. The Facility will utilize the 3 step method of soap/bleach/water for disinfecting purposes.
There are 93 chairs, 48 tables, and 89 mats in the Facility. LPA observed adequate equipment, supplies and toys that are is in good condition and safe for the preschool children in each room. Drinking fountain and water ptchers with disposable cups are available indoors and outdoors for the children. There is a working telephone at the site.
There have been no changes to the outdoor playground space available to the children in care.
OUTDOOR MEASUREMENTS ARE AS FOLLOWS (previously measured on 08/24/16 by LPA Mevin Matos):
PRESCHOOL PLAYGROUND:
63.417 x 48.000 = 3,044.016
64.417 x 56.167 = 3,618.109
66.750 x 85.000 = 5,673.750
TOTAL OUTDOOR SPACE: 12,335.875 sq. ft. divided by 75 = 164 children.

The playground areas utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient material on the outdoor playground areas. LPA did not observe any bodies of water.

The capacity of the License will remain for 89 children. The room addition and removal may be approved pending review and approval by a Licensing Program Manager (LPM).
No deficiency cited during today's visit.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

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