444417036-8-30-2022-07-CC-DMAC-CHSN8E-20220830101412

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444417036
Report Date: 08/29/2022
Date Signed: 08/30/2022 10:14:20 AM

Document Has Been Signed on 08/30/2022 10:14 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MIDTOWN MONTESSORI		FACILITY NUMBER:	444417036
ADMINISTRATOR:	JOACHIM WILLIAMS		FACILITY TYPE:	850
ADDRESS:	987 BOSTWICK LANE, CLASSROOM 1		TELEPHONE:	8314232273
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY: 25	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/29/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Balamuruga Subbiah		TIME COMPLETED:	03:40 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 Analysts (LPAs) Dung Mac and Mel Matos conducted an announced pre-licensing inspection and met with Balamuruga Subbiah, Applicant Representative, and Joachim Williams, Site Director, and explained the nature of today's inspection. The Facility is applying for a change of ownership. The existing facility is currently in operation (#444416980) on the same premises. A Fire Clearance was approved by Santa Cruz Fire Department on 8/24/2022. The Applicant Representative is applying for a license to serve 25 children ages 2-5 years old. The center will operate Monday through Friday from 8:30AM to 4:00PM. LPAs toured and measured the indoor and outdoor areas of the facility during today's visit. INDOOR ACTIVITY SPACE: (32.083 x 28.833) minus (5.083 x 4.417 + 4.083 x 2.167 + 4.000 x 1.333) (encumbered) = 886.025 *TOTAL INDOOR ACTIVITY SPACE:* *886.025 sq. ft. divided by 35 sq. ft / child = 25 children* Facility has 2 sinks (30) and 2 toilets (30) available for the children in the facility. The sinks used by children only have cold running water. Children who become ill will be isolated in the "Quiet Area" and isolation equipment will be provided. Sick children will use the staff bathroom if needed. Staff have a separate bathroom which is located outside the classroom. Balamuruga states that facility plans to administer medications to the children as needed. Report To Be Continued on Page #2

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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 3

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: MIDTOWN MONTESSORI	FACILITY NUMBER: 444417036
	VISIT DATE: 08/29/2022

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

LPAs observed the facility is clean and sanitary. The facility has appropriate lighting in classroom. LPAs observed a trash can with tight-fitting lid and smoke/carbon monoxide detectors in the classroom. LPAs observed the cleaning supplies are kept on high shelves inaccessible to children. Balamuruga states that there are no poisons at the facility. First aid supplies are stored in the 'Quiet Area" inaccessible to children. Medications are stored in the cabinet inaccessible to children. Transportation will not be provided by the facility.

There are 11 tables, 25 chairs, 26 cubbies, and 10 cots for the children. There are adequate equipment, supplies, and toys for the children in classroom. Drinking water will be readily available for the children indoor via water dispenser/individual water bottles. Children will bring their own lunch and snacks.

OUTDOOR MEASUREMENTS:

(44.583 x 17.833 + 77.750 x 60.000) minus (encumbered)
(5.000 x 5.333 + 11.417 x 7.750 + 6.833 x 25.083 + 26.667 x 9.750
4.500 x 8.750) = 4,874.132

Total outdoor space = 4,874.132 sq ft divided by 75 = 64 children

LPAs observed the playground is surrounded by appropriate fencing. No bodies of water were observed. LPAs observed the outdoor activity space is equipped with age-appropriate toys. The areas around and under the play structure is cushioned with resilient materials (poured rubber surfacing) that absorb falls. Drinking water will be readily available for the children outdoor via individual water bottles.

There is a separate program for special needs children operated by the Santa Cruz County Office of Education located adjacent to the facility and in a separate building (2 classrooms). Balamuruga states that preschool children will share the playground with special needs children but at different time intervals. LPAs informed Balamuruga that the facility will have to submit a waiver request for shared playground usage with Santa Cruz County Office of Education.

Report To Be Continued on Page #3

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MIDTOWN MONTESSORI	FACILITY NUMBER: 444417036
	VISIT DATE: 08/29/2022

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

This Facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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

LPAs reviewed with facility 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 the Facility Representative, Balamuruga Subbiah. LPAs advised Balamuruga that a license for 25 Preschool children will be submitted for the final stage of review by Licensing Management upon the receipt of the following:

1) Waiver request and playground schedules for shared playground

2) Updated indoor Facility sketch with children & staff bathrooms properly labeled
3) Additional cots/mats
4) Outstanding program corrections

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3