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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700625
Report Date: 06/13/2024
Date Signed: 06/13/2024 12:22:29 PM

Document Has Been Signed on 06/13/2024 12:22 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 MONTESSORIFACILITY NUMBER:
015700625
ADMINISTRATOR/
DIRECTOR:		RANI, PUSHPAFACILITY TYPE:
850
ADDRESS:1481 MOWRY AVENUETELEPHONE:
(408) 718-9911
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: DATE:
06/13/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Pushpa RaniTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On Thursday, June 13, 2024 at 10:00 AM, Licensing Program Manager, Mai Lor, Licensing Program Analyst Caroline Colson and Licensing Program Analyst Brindha Govindasamy met with Applicant Pushpa Rani, Harish Arora and Nanda Nandkishore for an office meeting to discuss the pending Change of Ownership application. During this meeting, the Applicant submitted the required documents and were reviewed to ensure compliance. The Title 22 regulations were discussed to ensure complete compliance. There are additional documents needed before the facility can be licensed. An updated fire clearance request will need to be submitted with updated facility sketches.

The following items were also discussed with the Applicant:

1. Ratio and staffing qualification (101216.1, 101416.5, 101516.5)
2. Buildings and grounds requirement (101238)
3. Volunteer requirement (101216)
4. Director qualification and requirements (101215.1)
5. Supervision (101229)
6. Children and staff records (101217, 101221)
7. Toddler component requirements (PIN 24-02, 101216.4)


Exit interview was conducted.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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