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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414879
Report Date: 11/22/2019
Date Signed: 11/22/2019 09:24:37 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 INCFACILITY NUMBER:
434414879
ADMINISTRATOR:MILINH VILLANUEVAFACILITY TYPE:
850
ADDRESS:2495 CABRILLO AVENUETELEPHONE:
(408) 418-3568
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:89CENSUS: 31DATE:
11/22/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Milinh VillanuevaTIME COMPLETED:
09:35 AM
NARRATIVE
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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 of the facility today. LPA observed 31 children with five (5) Teachers. During LPA’s previous annual inspection, LPA was informed of Room name changes and adjustments to the rooms being used for the daycare program. LPA observed the facility has changed the previously approved on limits area and repurposed and began using the previous designated Kitchen as a classroom (Pinnacles) for the past year and a half. Licensing was not advised of the structural change as required by Licensing regulations.

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.

LPA also needed to remeasure the Pinnacles classroom as adjustments to the bathroom and nap room have changed the approved use space.

The facility previous measurements of rooms on 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
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
REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 11/22/2019):
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2019
Section Cited

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Alterations to Existing Buildings or New Facilities. Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).
This requirement was not met as evidenced by: LPA observed the facility has changed the previously approved on limits area
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and repurposed and began using the previous designated Kitchen as a classroom (Pinnacles) for the past year and a half. Licensing was not advised of the structural change as required by Licensing regulations.
This poses a potential risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: 11/22/2019
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 11/22/2019):
The updated measurements for the Pinnacles Classroom are as follows:
Pinnacles: 22.167 x 27.75 = 615.13425 - 0 encumbered space= 615.134
Pinnacles cont’d (Kitchenette): 19.25 x 14.25 = 274.3125 - 0 encumbered space = 274.313
Pinnacles cont’d (Nap area): 21 x 14.167 = 297.5070 – 11.519 encumbered space = 285.988
TOTAL INDOOR CAPACITY SPACE: 3717.579 Divided by 35 (SQ. FEET) = 105.887

The facility has also opened an additional bathroom for the children to use in the Yellowstone classroom. This provides 9 sinks (135), 7 toilets (105), 1 urinal (15) available for the preschool children.

Tittle 22 deficiency was cited on the attached 809D page during today's visit.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3