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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700590
Report Date: 12/02/2022
Date Signed: 12/02/2022 03:21:56 PM

Document Has Been Signed on 12/02/2022 03:21 PM - It Cannot Be Edited

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:LEVEL UP MONTESSORIFACILITY NUMBER:
015700590
ADMINISTRATOR:AGARWAL, SANDHYAFACILITY TYPE:
830
ADDRESS:31145 MISSION BOULEVARDTELEPHONE:
(510) 516-4443
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
12/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sandhya AgarwalTIME COMPLETED:
03:25 PM
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On 12/02/2022, a Prelicensing Visit was conducted today by Licensing Program Analyst (LPA), Melanie Otsuji. LPA met with Applicant, Sandhya Agarwal. The applicant has submitted an application for an INFANT license. A health and safety inspection was conducted inside and outside. The infant program will operate in 1 classroom (Blue Room). Also on site is a Preschool Component operating out of 4 classrooms (Classrooms Green, Orange, White and Purple). Operating Monday through Friday from 7:30AM - 5:00PM. The measurements are as follows:

INDOORS: 450 square feet = 12 children
OUTDOORS: 3372.24 square feet = 45 children

Classrooms are equipped with varied age appropriate materials and equipment. There is a changing table within arms length of a sink. There is 1 sink located within the classroom. Office and staff bathroom will serve as isolation area for ill children. There is a total of 1 play yard for the preschool, toddler and infant aged children. The infant yard is barricaded and Director/Applicant understands that children are not to commingle. Building overhang provides sufficient shade in all play yards. Children bring AM/PM snacks from home and facility will have back up snack supplies on hand. Facility has catered lunch for children. Cabinets with cleaners are locked and/or inaccessible to prevent access to children. Facility will utilize electronic sign in and out. The system allows for a unique identifier and records the date and time of day.
This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEVEL UP MONTESSORI
FACILITY NUMBER: 015700590
VISIT DATE: 12/02/2022
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The center has received an approved fire clearance from Hayward Fire Department on 11/2/2022.

Sundari Ganesan is a fully qualified preschool/infant director and has completed 16 hours of health and safety training including pediatric CPR and First Aid. Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A license for 12 infant aged children will be issued effective today, 12/02/2022.



Exit interview conducted with facility representative, Sandhya Agarwal.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC809 (FAS) - (06/04)
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