015700625-5-8-2024-52-CC-CCON-D544JU-20240508190920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700625
Report Date: 05/08/2024
Date Signed: 05/08/2024 07:09:34 PM

Document Has Been Signed on 05/08/2024 07:09 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	MOUNT VALLEY MONTESSORI		FACILITY NUMBER:	015700625
ADMINISTRATOR/ DIRECTOR:	RANI, PUSHPA		FACILITY TYPE:	850
ADDRESS:	1481 MOWRY AVENUE		TELEPHONE:	(408) 718-9911
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 86	DATE:	05/08/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:31 PM
MET WITH:	Rani Pushpa		TIME VISIT/ INSPECTION COMPLETED:	07:23 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	On Wednesday, May 8, 2024, at 1:35 PM, Licensing Program Analysts, Caroline Colson and April Wright met with Applicant Pushpa Rani, for the purpose of an unannounced Change of Ownership prelicensing inspection. The applicant requests 6 Toddlers from 18 months to 36 months, 114 preschool children from 2 years of age to first grade entry, and 15 school age children from 4.9 to 12 years of age. A health and safety inspection in all areas accessible to children was conducted. There are 86 children and 11 staff members including the applicant. The program will operate Monday through Friday from 8:00 AM to 6:00 PM. Physical Plant: The facility is a one (1) story building with four (4) classrooms. There are toilets and two sinks in each classroom. There is adequate heating, lighting, and ventilation. There are no cleaning solutions, chemicals, or other hazards accessible to children. Per Applicant, there are no weapons at the facility. Classrooms: Furniture and equipment are age appropriate and in good repair. There are separate storage areas for children’s belongings. Drinking water will be provided and distributed in labeled water bottles for all children. Children do take naps at facility. There are mats and bedding materials for all the children. Parent will wash all bedding materials every Friday. Staff will sanitized the mats every Friday. There is a first aid kit in the staff bathroom. The facility provides three snacks and a lunch. The menu is posted for review. Food is available and in quantity necessary to meet the needs of the children in care. Please See LIC 809 C for Additional Information

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MOUNT VALLEY MONTESSORI	FACILITY NUMBER: 015700625
	VISIT DATE: 05/08/2024

NARRATIVE

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Restrooms: Toilets and sinks are operable. There is soap, toilet paper and a hand dryer for sanitary use.

Classroom measurements:
LPA measured four (4) classrooms. The indoor total measurements contain a total of 3988.242 square feet which will accommodate Applicant’s request for preschool children. The total indoor measurements contain a total of 393.97 square feet which will accommodate Applicant's request for Toddler children. The total indoor measurements contain a total of 521.63 square feet which will accommodate Applicant's request for School Age children.

There are a total of 9 toilets and 9 sinks for all children. There are two staff bathrooms and the director's office are the isolation areas.

Outdoor Activity Space:
There is one outdoor area on the property. The outdoor play area is fenced with a wooden fence and the church building wall that are at least four feet tall. There is enough age-appropriate equipment and toys. The play structure includes a safety label, which designates use for children. There is cushioning material underneath all outdoor climbing equipment. There are no bodies of water on the premises. There is a shaded area that includes an extended roof to cover the area. Climbing structures, swings, slides are safe and in good condition. Playground is free of debris and other hazards. Children have access to drinking water and will use their own water bottles outside.

Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The total outdoor measurements were based on the previous measurements from the prelicensing inspection on February 10, 2023 which is 6999.14 square feet, which will not accommodate Applicant's request for the Preschool, School and Toddler children.

Please See LIC 809 C for Additional Information

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MOUNT VALLEY MONTESSORI	FACILITY NUMBER: 015700625
	VISIT DATE: 05/08/2024

NARRATIVE

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Emergency Preparedness/Safety: Emergency Disaster Plan is dated and posted for review. The facility utilizes a land line telephone and cell phones. Fire Clearance is under review because the occupancy class is the letter "E".

Sign in/Sign out: Applicant stated an electronic sign in and sign out process will be utilized, and paper sign in/sign out is also available.

Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure. LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep web page 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.

Please See LIC 809 C for Additional Information

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MOUNT VALLEY MONTESSORI	FACILITY NUMBER: 015700625
	VISIT DATE: 05/08/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 ADA, available at http://www.ada.gov/childqanda.htm

LPA reviewed with Applicant the LIC 311 A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed 100% supervision is always required in all areas that children have access to including the bathroom. Personal Rights, inspection authority, reporting requirements, maintaining buildings and grounds was reviewed. Staff Qualifications, Staff to Children’s ratios and Capacity was explained to ensure compliance. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Please See LIC 809 C for Additional Information

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MOUNT VALLEY MONTESSORI	FACILITY NUMBER: 015700625
	VISIT DATE: 05/08/2024

NARRATIVE

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Exit interview was conducted with Applicant, Pushpa Rani.

The following items are required before a license will be issued:

1. Resubmit LIC 309 without completing section lll.
2. Please resubmit LIC 401 with actual figures and maximum capacity revenue
3. LIC 500 – Please complete a separate form for each component and identity each position with a signature on second page.
4. Please provide Safe Sleep information for infants, equipment and required documentation needed.
5 Please state the correct hours of operation throughout all submitted documents that is listed on your LIC 200 A.
6. Please add Personal Rights near Discipline in the Parent Handbook.
7. Please include all the Employee Rights information in the Employee Handbook.
8. Please include In-Service Training and Fremont resources in the Employee Handbook.
9. Please include Reporting Requirements for Community Care Licensing and Child Protection Services.
10. Please separate each job position including Director, Teacher, Teacher Aide and Cook.
11. Please identity line of supervision clearly in each job description.
12. Please submit a clear facility sketch for each component with dimensions, locations, and toilets/sinks.
13. Please ensure there is a separate four feet wall between the preschool and school age and individual measurements for this classroom.
14. Please add the Toddler Option Statement and the signature line for the parent in the Admission Agreement.
15. All fees need to be clearly stated and the payor in the Admission Agreement.
16 Please include DOJ, FBI and CACI with stating a criminal record clearance is needed.
17. Sample Menu – Are you providing any drinks for the children.

Please See LIC 809 for Additional Information

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MOUNT VALLEY MONTESSORI	FACILITY NUMBER: 015700625
	VISIT DATE: 05/08/2024

NARRATIVE

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18. Update the Infant Needs and Service Plan to ensure all required information is included in the forms.
19. Please provide verification letters for your relocation sites.
20. Please provide verification of when the building was built.
21. Please provide a bank statement.
22. Please provide a section for IMS Plan in the Parent Handbook.
23. Please provide a list of all required documents for parents to submit in the Parent Handbook and criteria for determining appropriate placement under Admission Policies.
· Please provide individual schedules for each component
· Please provide work shifts for employees in the Employee Handbook.
· Please add Mandated Reporter Training and DOJ, FBI and CACI in Pre-Employment 24. Director Documents
Please submit a TB clearance or a letter from the physician
Please provide the 8 hours Preventative Health Training certificates.
Verification of Employment.

25. Waivers are needed for outdoor play space.
26. Applicant will need to replace a toilet tissue in the first bathroom.
27. Toddler play space has different areas that are tripping hazards.
28. Applicant will need to purchase 4ft high dividers for two classrooms that have two components
29. Applicant will need to talk with the Fire Department about their E Occupancy class clearance.
30. Applicant will need to create a barrier for both sides of the outdoor play space that leads to the electrical panel and inaccessible area.
31. A new gate is needed to replace the gate for the shed.
32. Soap is needed for one sink.
33. Antiseptic Solution is needed all first aid kits. .
34. Applicant will need to purchase maximum amount of chairs and tables for all programs.
35. There is one wall on the Toddler play space is sinking and two walls on shared yard is sinking.
36. LPM needs to provide a final review.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC809 (FAS) - (06/04)

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