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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417036
Report Date: 05/31/2022
Date Signed: 05/31/2022 04:27:10 PM

Document Has Been Signed on 05/31/2022 04:27 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:MIDTOWN MONTESSORIFACILITY NUMBER:
444417036
ADMINISTRATOR:JOACHIM WILLIAMSFACILITY TYPE:
850
ADDRESS:987 BOSTWICK LANETELEPHONE:
(831) 423-2273
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 0DATE:
05/31/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Balamurugan SubbiahTIME COMPLETED:
04:00 PM
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Office visit to review second submission of application for a child care center license. LPM Mary Segura met with applicant representative Bala Subbiah to review items that still require correction and/or updating prior to a license being granted. In addition to the items listed below a fire clearance, verification of three months start up costs and a prelicensing inspection will be required prior to a license being granted. This applicant may not operate without first obtaining a license.

1. LIC 200 needs updating,
2. Control of property is missing classroom number.
3. LIC 309 needs updating,
4. LIC 401 needs updating.
5. LIC 403 a is missing
6. LIC 500 needs updating
7. LIC 610 needs updating
8. LIC 999 needs updating.
9. Missing board resolution appointing director.
10. Missing current TB test for Bala Subbiah.
11. Missing verifications for director Sybil Bansal.
12. Job descriptions need updating.
13. Employee Handbook needs updating.
14. Staff in service training needs to be updating
15. Admission agreement needs updating.
16. Parent handbook needs updating.
17. Equipment list needs updating.

Applicant was given a detailed list of the items that need to be corrected in the above documents.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Mary Segura
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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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