<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444406706
Report Date: 06/24/2021
Date Signed: 06/28/2021 07:23:39 AM

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:MONTESSORI SCOTTS VALLEYFACILITY NUMBER:
444406706
ADMINISTRATOR:MADELYNN TERSHYFACILITY TYPE:
850
ADDRESS:123 SOUTH NAVARRA DRIVETELEPHONE:
(831) 439-9313
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY:84CENSUS: 55DATE:
06/24/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:MADELYNN TERSHY TIME COMPLETED:
01:40 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 Analyst (LPA) Stephanie Collins conducted a site inspection of the facility today and met with Director Madelynn Tershy . LPA explained to her the purpose of the Case management, the inspection is in response to facility’s request for an increase in the preschool licensed capacity from 84 to 96 to accommodate the requested increase the preschool will be adding 2 rooms; Primary Rooms 1 and 2 to their total sq. footage of activity space. A Fire Clearance has been granted on 06/15/21. LPA observed 55 children and 8 staff.
During today’s inspection the following measurements where taken.
(Total sq. ft.) – (Encumbered sq. ft.) = (Total sq. ft.)
Primary Room 1
(14.1 ft. ) x (13.4 ft.) = 188.94 sq. ft. – (0 Encumbered sq. ft.)
= 188.94
Primary Room 2
(13.5 ft.) x (9.5 ft.) = 128.25 sq. ft.
(9.33 ft.) x (3.4 ft) = 31.72 sq. ft. – ( 0 Encumbered sq. ft. )
= 31.72
Preschool Dolphins Room:
(34. ft) x (35. ft) =1190.00 sq. ft. – (24.59 sq. ft. ) = 1165.41sq.ft
Preschool Otters Room:
( 30.25 ft.) x (34.83 ft.) = 1053.61 sq. ft. – (41.05 sq. ft) = 1012.56 sq. f t.
Measurement taken 11/06/2018
Toddler Classroom 1
(499.694 sq. ft). – (21.127 sq. ft )
= 478.566 sq. ft.
Toddler Classroom 2
((499.079 sq. ft.) – (22.752)
= 426.326

Total Activity Space 3,431.77 Divided by 35 (Sq. feet) = 98 children


SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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 2
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: MONTESSORI SCOTTS VALLEY
FACILITY NUMBER: 444406706
VISIT DATE: 06/24/2021
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
26
27
28
29
30
31
32
Outdoor measurement are as follows
(Taken from 11/06/2018 report)
Preschool Playground: = 5,039.607 sq.ft.
Toddler Playground= 2,964. sq. ft.
Garden Area = 1458.291 sq. ft
5039 + 2964. + 1458.291 = 9461.297 divided by 75 = 126

Based on LPA’s measurement and observation, the facility does meet the square footage requirement to increase capacity from 84 to 96. The increase capacity is approved pending management final review and approval


A notice of Site visit has been issued and must remain posted for 30 days.



No deficiencies have been cited as a result of today inspection. Exit interview conducted with administer Madelyn Tershy .
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2