444416980-6-4-2021-07-CC-DMAC-C3NRHV-20210604130259

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416980
Report Date: 06/04/2021
Date Signed: 06/04/2021 01:03:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MIDTOWN MONTESSORI		FACILITY NUMBER:	444416980
ADMINISTRATOR:	DONNA CHERIE		FACILITY TYPE:	850
ADDRESS:	987 BOSTWICK LANE, CLASSROOM 1		TELEPHONE:	(831) 423-2273
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY:	30	CENSUS: 0	DATE:	06/04/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Donna Cherie, Applicant		TIME COMPLETED:	01:15 PM

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 Analysts (LPAs) Dung Mac and Ofelia Calivo conducted an announced prelicensing visit. LPAs met with Donna Cherie, Applicant, Charlotte (Sibyl) Bansal, Site Director, and Joachim William, Head Teacher. The Pre-licensing visit is a result of a change of ownership. The Applicant is applying for a License to serve 30 children ages 2.5-6 years old. The Center will operate Monday through Friday from 08:30AM to 08:30PM. LPAs toured and measured the indoor and outdoor areas of the facility during today's visit. INDOOR ACTIVITY SPACE: Room 1: (32.083 x 29.083) minus (11.417 x 2.083 + 1.583 x 4.250 + 1.250 x 1.291) (encumbered) = 901.16 *TOTAL INDOOR ACTIVITY SPACE:* *901.16 sq. ft. divided by 35 sq. ft / child = 25 children* Facility has 2 sinks (30) and 2 toilets (30) for children to use. The sinks used by children only have cold running water. Children will bring their own lunch and snack at this time. Children who become ill will use the isolation bathroom and will be isolated in the owner/isolation room with isolation equipment. Staff have separate bathrooms which are located outside the classroom. LPAs observed a trash can with tight-fitting lid and smoke/carbon monoxide detectors in classroom. LPAs observed the cleaning supplies are kept on high shelves inaccessible to children. First aid supplies are stored in the office. Donna states that the medications will be stored in the office.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

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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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: MIDTOWN MONTESSORI	FACILITY NUMBER: 444416980
	VISIT DATE: 06/04/2021

NARRATIVE

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There are 12 tables, 30 chairs, 26 cubbies, and 30 mats for the children There are adequate equipment, supplies and toys for the preschool children in classroom. Drinking water is readily available for the children indoor via water dispenser/disposable cups. and outdoor playground area via pitchers/disposable cups.

OUTDOOR MEASUREMENTS:

(45.000 x 7.917 + 77.833 x 60.000) minus
(26.667 x 9.750 + 11.417 x 7.667 + 4.583 x 8.917) = 4,637.85

Total outdoor space = 4,637.85 sq ft divided by 75 = 61 preschool children

LPAs observed the playground is surrounded by appropriate fencing. No bodies of water were observed. LPAs observed the outdoor activity space is equipped with age-appropriate toys and equipment. Shade is provided by umbrella and building overhangs. The areas around and under the play structures are cushioned with material that absorbs falls. Drinking water is readily available for the children outdoor via water dispenser/disposable cups.

Incidental Medical Services (IMS) policy was discussed. Applicant was provided the information regarding ADA: toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: http://www.ada.gov/childqanda.htm.

LPAs reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the facility, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

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: MIDTOWN MONTESSORI	FACILITY NUMBER: 444416980
	VISIT DATE: 06/04/2021

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There is a separate program for special needs children operated by the Santa Cruz County Office of Education located adjacent to the facility and in a separate building (2 classrooms). Donna stated that preschool children will share the playground with special needs children but at different time intervals.

LPAs conducted an exit Interview and advised Donna that a license for 25 Preschool children will be submitted for the final stage of review by Licensing Management upon the receipt of the following:
1) Waiver request and playground schedules for shared playground.
2) Proof of registration of Child, Family, and Community course.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

LIC809 (FAS) - (06/04)

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