434417055-10-12-2022-07-CC-MMOO-CK5RHZ-20221012130311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417055
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:03:21 PM

Document Has Been Signed on 10/12/2022 01:03 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LEVEL UP MONTESSORI SAN JOSE		FACILITY NUMBER:	434417055
ADMINISTRATOR:	SAPNA RASTOGI		FACILITY TYPE:	850
ADDRESS:	4868 SAN FELIPE ROAD #130		TELEPHONE:	(408) 718-3316
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/12/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Sapna Rastogi, Manish Rastogi, & Sandhya Agarwal		TIME COMPLETED:	01:20 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	Licensing Program Analysts (LPAs) Marilou Monico and Janette Cruz met with Applicant Representative, Sapna Rastogi, Managing Members, Manish Rastogi and Sandhya Agarwal, for the purpose of conducting a pre-licensing inspection. This was in response to an application for a change of ownership. The Preschool Program will operate Monday through Friday from 7:30 AM to 6:00 PM, serving preschool children ages 2-6 years old. The Preschool program will be utilizing Preschool Rooms 1 thru 5. LPAs toured and measured the indoor and outdoor areas of the facility during today's inspection. Indoor Activity Space: ROOM 1: 20.000 x 18.500 = 370.009 minus 6.562 (encumbered space) = 363.447 ROOM 2: 24.000 x 24.667 = 592.008 minus 12.061 (encumbered space) = 579.947 ROOM 3: 31.500 x 14.417 = 454.135 minus 62.564 (encumbered space) = 391.571 ROOM 4: 39.500 x 29.250 = 1155.375 minus 75.803 (encumbered space) = 1079.572 ROOM 5:41.417 x 22.417 = 928.445 minus 12.233(encumbered space) = 916.212 *TOTAL INDOOR SPACE = 3330.749 sq. ft. divided by 35 = 95 children* The facility has 6 sinks (90), 6 toilets and 1 urinal (105) available for the children. The sinks to be used by children only have cold running water. Staff bathroom is located in Preschool Room 2. The sick children will be using the staff bathroom if needed. Sick children will be isolated in the Director's Office and isolation equipment will be provided. Staff and children's bathrooms are clean, sanitary, and operable. *Continuation on Page 2*

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LEVEL UP MONTESSORI SAN JOSE	FACILITY NUMBER: 434417055
	VISIT DATE: 10/12/2022

NARRATIVE

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LPAs observed containers with tight-fitting lids for the disposal of solid waste. First aid supplies are stored in Rooms 2 and 4 inaccessible to children. Cleaning supplies are stored in a locked closet in Preschool Room 4. LPAs observed functioning smoke/carbon monoxide detectors and appropriate lighting in each classroom. The facility has central heating and air conditioning. Sapna stated that the facility will not be administering medications.

Sapna understands that the facility must be kept free of flies, other insects & rodents. LPAs observed that all furniture and equipment indoors are in good condition and safe for the children. Drinking water will be readily available for the children indoors via individual water bottles and drinking fountains. Transportation will not be provided by the facility.

The facility will not be providing meals and snacks. Parents have the option to purchase lunch from an outside vendor (School Caterers) or bring their children's lunch. The facility has an off-limits kitchen. The kitchen is clean and equipped with a sink with cold running water, refrigerator, and storage space for food. Disposable utensils and plates will be utilized by the facility.

There are 14 tables, 82 chairs, 122 cubbies, 30 cots, and 15 mats for the children. The facility ordered 16 additional cots and proof of purchase was submitted during the inspection. There is adequate supplies and toys for the preschool children in each classroom. Some of the children will be attending on a part-time basis and will not nap at the center.

OUTDOOR MEASUREMENTS:
PLAYGROUND: 80.750 x 42.750 = 3,452.062
14.833 x 5.833 = 86.520
PLAYGROUND TOTAL = 3,538.582 minus 443.389 (encumbered space) = 3,095.193
TOTAL OUTDOOR SPACE = 3,095.193 sq. ft. divided by 75 = 41 children

LPAs observed the playground is fully fenced and meets the height requirements. Shades are provided by trees, umbrellas, and building overhang. The areas under and around the play structure is cushioned with material (rubber foams) that will absorb a fall. Drinking water will be provided by individual water bottles and drinking fountain. No bodies of water were observed.
Continuation on Page 3

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LEVEL UP MONTESSORI SAN JOSE	FACILITY NUMBER: 434417055
	VISIT DATE: 10/12/2022

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LPAs observed a spider web climbing structure in the playground that was not anchored to the ground. The structure was removed in the playground during the inspection. LPAs advised Sapna and Sandhya that prior to using the spider web structure for the children, they will ensure that it is anchored to the ground.

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 the ADA, available at: http://www.ada.gov/childqanda.htm.

Applicant Representative 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.

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

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.

Exit interview conducted and report was reviewed with Sapna Rastogi, Applicant Representative, and Managing Member, Sandhya Agarwal. LPAs advised them that a license for 82 preschool children will be submitted to Licensing Management for the final stage of approval.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

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