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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625983
Report Date: 11/05/2024
Date Signed: 11/05/2024 11:07:28 AM

Document Has Been Signed on 11/05/2024 11:07 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HAGGINWOOD MONTESSORIFACILITY NUMBER:
343625983
ADMINISTRATOR/
DIRECTOR:		ANOMA MUDANNAYAKEFACILITY TYPE:
860
ADDRESS:3240 MARYSVILLE BLVD.TELEPHONE:
(808) 651-1169
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 0DATE:
11/05/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Anoma MudannayakeTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 11/05/2024, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat met with applicant Anoma Mudannayake for the purpose of an announced pre-licensing inspection. This is a change of ownership application from the previous licenses 343624402 and 343623719. The Applicant requests the following components for their program: An infant component which will serve 4 infant children ages 0-24 months and a preschool component which will serve 28 children ages 2 years to entry into kindergarten.

The program will operate 7:00 AM - 6:00 PM Monday through Friday. The initial fire clearance was granted on 08/24/2024 by the Sacramento City Fire Department. During this visit, LPA Manabat and the applicant reviewed the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, Menus, and Daily schedule. Applicant stated that the facility does provide AM and PM snacks but that parents/guardians will need to provide lunch.

INDOOR ACTIVITY SPACE:
During the inspection, LPA Manabat observed 1 room for the infants and one larger open classroom for preschool children. During today's visit, LPA Manabat observed a sufficient amount of age-appropriate equipment, toys, tables, and cubbies. The applicant is planning on purchasing first aid kits for each of the classrooms. The Applicant stated that the medications are stored in the front office and that there are no firearms or bodies of water on the premises. Indoor and outdoor drinking water will be provided via water jugs. During today's visit, LPA Manabat did not observe a functioning carbon monoxide detector within the facility but, the applicant stated that she will be purchasing one today.

(Report continued on subsequent LIC 809)
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HAGGINWOOD MONTESSORI
FACILITY NUMBER: 343625983
VISIT DATE: 11/05/2024
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According to the Applicant, the sign-in/sign-out system is conducted via a paper sign-in sign-out sheet. Additionally, during today's visit, LPA Manabat measured all classrooms intended for program use. LPA Manabat measured a total of: 140.10 square feet for the infant classroom and 987.53 square feet for the preschool classroom. These measurements indicate that there is enough space to accommodate for the 4 infants and 28 preschool children respectively.

In the infant room there are two sinks and one changing table, which is within arms reach of a sink. LPA Manabat observed four cribs in the infant room. In the preschool program there are a total of two toilets and two sinks available. For all components, the number of toilets and sinks will accommodate the facility's requested capacity. There is also a private restrooms for the staff located in the hallway of the center. It was stated that any child(ren) who become ill during the day will be isolated in office area. These children will utilize staff restrooms. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
During today's visit, LPA Manabat observed one outdoor yard on site. Both the infant and preschool components will utilize the same yards. LPA Manabat observed one large canopy that spans the entirety of the yard. There are no permanent play structures fixated to the yard and the floor is cushioned by green floor mats. Finally, LPA Manabat observed a sufficient amount of age appropriate equipment and toys for all outdoor play areas.

LPA measured a total of 1064.51 square feet for the yard. During today's visit, LPA Manabat and the applicant discussed plans to utilize the single yard for both infants and preschoolers. LPA Manabat stated that the applicant would need an approved outdoor waiver request to share the yards for both programs. LPA Manabat also mentioned that the measurements indicate that the yard will not accommodate the Applicant's request for 28 preschoolers. LPA Manabat stated that the the applicant would also need to address the insufficient space in their waiver request.

(Report continued on subsequent LIC 809)
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HAGGINWOOD MONTESSORI
FACILITY NUMBER: 343625983
VISIT DATE: 11/05/2024
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LPA discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPAs 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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 the ADA, available at: http://www.ada.gov/childqanda.htm.

Facility Representatives 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.

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.
(Report continued on subsequent LIC 809)
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HAGGINWOOD MONTESSORI
FACILITY NUMBER: 343625983
VISIT DATE: 11/05/2024
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The following item is required before a license will be issued:

1. Manager approval by Licensing Program Manager (LPM) Mai Lor.


2. An amended fire clearance to reflect the 28 preschoolers. This document is to be received by the fire department
3. A carbon monoxide detector
4. First Aid kits
5. LIC200A for 28 preschoolers and 4 infant children
6. A waiver for insufficient/shared space waiver for the outdoor play space.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4