015700593-2-10-2023-52-CC-MOTI-CNWTMG-20230210135108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700593
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:51:19 PM

Document Has Been Signed on 02/10/2023 01:51 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:	MOUNT VALLEY MONTESSORI INC.		FACILITY NUMBER:	015700593
ADMINISTRATOR:	JAGGA, URVASHI		FACILITY TYPE:	840
ADDRESS:	1481 MOWRY AVENUE		TELEPHONE:	(510) 491-7006
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 15	CENSUS: 0	DATE:	02/10/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Urvashi Jagga		TIME COMPLETED:	02:10 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	An announced Prelicensing Visit was conducted today by LPA Mayla Mendoza. LPA met with center owner, Urvashi Jagga. The applicant has submitted an application for a change in ownership for a school-age license. The center is currently licensed for a preschool program (license #015700592, capacity 120). The school-age program will be operating in a section of the Busy Bee classroom (1st classroom on the left upon entering). Hours of operation will be from 8:00am-6:00pm, Monday through Friday. A health and safety inspection was conducted inside and outside and the measurements are as follows: INDOORS: 554.56 square feet = 15 children OUTDOORS: 6999.14 square feet = 93 children A fire clearance was approved by the Fremont Fire Dept. on 1/20/2023. The classroom is equipped with age appropriate materials and equipment. The school-age program will share the yard with the preschool program, but center will ensure the 2 programs will not commingle. The yard is fenced in all around. There is shade available for the children in the play yard. There is 1 sink and 1 toilet available for school age children and provide privacy. The isolation area for sick children will be the staff bathroom and the office. There are mats available for tired or sick children. The facility serves lunch and snacks, and there is a kitchen with refrigeration and hot water. Drinking water is available inside and outside. The center has first aid supplies and carbon monoxide available. 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: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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: MOUNT VALLEY MONTESSORI INC.	FACILITY NUMBER: 015700593
	VISIT DATE: 02/10/2023

NARRATIVE

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Urvashi Jagga is a fully qualified school age 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.

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 15 school aged children will be issued effective today 2/10/2023. Yard waiver to be posted with license upon receipt.

Exit interview conducted with Applicant, Urvashi Jagga.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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