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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700617
Report Date: 08/09/2023
Date Signed: 08/09/2023 05:00:53 PM

Document Has Been Signed on 08/09/2023 05:00 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:LEARN & PLAY MONTESSORI DUBLIN, INC.FACILITY NUMBER:
015700617
ADMINISTRATOR:PAI, JENNYFACILITY TYPE:
850
ADDRESS:3960 SUMMIT ROADTELEPHONE:
(925) 951-5123
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 164TOTAL ENROLLED CHILDREN: 164CENSUS: 0DATE:
08/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Jaskirin GrewalTIME COMPLETED:
05:05 PM
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A Prelicensing inspection was conducted today 8/9/2023 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Applicant, Jaskirin Grewal. The applicant has submitted a NEW application for a PRESCHOOL license for 164 preschoolers with the option to have 24 of those be enrolled into the toddler-option (18 months-36 months program). The program will operate from 7:30AM - 6PM, Monday through Friday, in 8 classrooms (Classrooms 1A/1B, 2, 3, 4, 5, and 6A/6B). Also on site is a School Age component (max cap: 41) operating out of 2 classrooms. A health and safety inspection was conducted inside and outside and the measurements are as follows:

INDOORS: 6554.55 square feet = 187 children
OUTDOORS: 5045.85 square feet = 67 children

The center has obtained an approved fire inspection clearance from the Dublin Fire Prevention on 7/28/2023.

The facility consists of 8 classrooms. Classrooms 2, 3, 4, 5, 6A/6B are for preschool aged children and classrooms 1A/1B allow enough space for 24 toddlers in the toddler-option program. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 15 toilets and 21 sinks available for children use. Staff toilet is located within the hallway. Facility will provide AM/PM snacks and children will bring lunch from home. Menu will be posted at least one week in advance in a place visible for the authorized representative to see. Facility will utilize the conference room and isolation bathroom as necessary for an ill child. Mats were observed today. Edith Vasquez is a fully qualified director and a complete director packet has been submitted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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: LEARN & PLAY MONTESSORI DUBLIN, INC.
FACILITY NUMBER: 015700617
VISIT DATE: 08/09/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (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
LPA reviewed with Applicant the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
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 the Applicant of the importance of checking for 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.

Applicant was informed of the MyChildCarePlan.org site, 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.

Exit interview conducted and report was reviewed with the applicant, Jaskiran Grewal.

A license for 164 preschool children, which includes up to 24 toddlers in the toddler-option program, will be issued effective today 8/9/2023. Facility is aware that School Aged and Preschool Aged children shall never commingle and facility capacity should never exceed 164 children at any given time. Yard waiver to be posted with license upon receipt.

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 platforms.
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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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