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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010650
Report Date: 07/09/2024
Date Signed: 07/09/2024 12:13:30 PM

Document Has Been Signed on 07/09/2024 12:13 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BRUSH CREEK MONTESSORI SCHOOLFACILITY NUMBER:
493010650
ADMINISTRATOR/
DIRECTOR:		MORRELL, SUSANFACILITY TYPE:
860
ADDRESS:4676 MAYETTE AVENUETELEPHONE:
(707) 539-7980
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 0DATE:
07/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Susan MorellTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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During today's visit, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat and LPA Amy Strother met with the Licensee Representative Susan Morrell for the purpose of an announced pre-licensing inspection. The Applicant is requesting to serve 66 preschool children ages two years to entry into first grade during the hours of Monday through Friday from 8:00am - 5:00pm. The facility is located on the Beth Ami synagogue site and is using rooms 1/2,3/4,5/6,and 7/8.

The facility's policy for food service is that parents/guardians will be providing lunch to their children and that the morning and afternoon snacks are going to be provided via the facility. The facility will allow parents to bring/donate snacks to the facility. Additionally, LPAs reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:
There are 4 classrooms and each classroom contains a sliding divider that hangs from the ceiling. The dividers are not being permanently used for the classrooms but they can divide up the rooms in half if staff choose to do so. LPAs observed that there are appropriate preschool supplies currently displayed in each classroom. The facility representative was reminded that any items that need to have teacher supervision, such as age appropriate scissors, should be stored inaccessible to children until ready to use. There are first aid kits located in each classroom. Any medications will also be stored inaccessible to children. The facility representative stated that medications that need to be refrigerated will stored in the kitchen refrigerator. LPAs observed cleaning disinfectants are appropriately stored and inaccessible to children in the resource area for staff members.

Report continues on LIC809-C
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BRUSH CREEK MONTESSORI SCHOOL
FACILITY NUMBER: 493010650
VISIT DATE: 07/09/2024
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The Applicant stated there are no poisons, bodies of water, or firearms on the premises. LPA Manabat discussed the importance of storing any poisons in a locked area with either a combination or a key lock.
LPAs observed a functional carbon monoxide detector and fire extinguisher. LPAs discussed the sign-in/sign-out sheet system and the applicant stated that this will be using an electronic sign in and sign out system on an electronic app system. Water will be provided to the classroom via water filters that will be refilled via the classrooms sinks.

INDOOR MEASUREMENTS:
LPAs measured the classroom space during today's visit. The classroom space contains a total of 2787.65 square feet, which will accommodate Applicant's request for 66 preschool children. There are 4 toilets and 12 sinks located in the facility. Three of the toilets are child-sized toilets located in the same bathroom and the fourth toilet is an adult sized toilet in the restroom next to the other three. The facility representative has acknowledged that the adult sized toilet will have a stool to accommodate children's needs. LPAs have noted that the number of toilets available for children to use corresponds to 60 children which will not accommodate the requested capacity of 66 children. The Licensee Representative stated that there was a separate private restroom for the staff located in the synagogue. The synagogue will be open all day. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the front office with a staff member. There will be a mat available in this space.

OUTDOOR ACTIVITY SPACE:
There are two outdoor activity play spaces on the property. The outdoor play areas are fenced with a combination of a wrought iron and a chain linked fences that are at least four feet tall. During today's visit, LPAs observed that the bushes and trees would need to be maintained to ensure 100% supervision. Additionally, LPAs noted that there were two fixed play structures in play space #2. These structures have enough substrate underneath to cushion a fall. The Facility Representative was reminded to follow the safety label and/or manufacturing guidelines for the structure. Measurements were taken for the outdoor space footage.

Shade provided via trees and water is provided via water bottles that can be refilled by the filtered water jugs. There are sufficient amount of equipment and toys and additional equipment stored in an outside shed. The Licensee Representative stated that the shed remains locked throughout the day and that staff will have access to the code. Report continues on LIC809-C.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BRUSH CREEK MONTESSORI SCHOOL
FACILITY NUMBER: 493010650
VISIT DATE: 07/09/2024
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LPAs measured the outdoor activity space. The outdoor play area contains a total of 6105.49 square feet, which will accommodate the requested capacity of 66 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 discussed the following: 100% supervision is required at all times, including in the bathroom; 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.

Applicant 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

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 continues on LIC809-C
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BRUSH CREEK MONTESSORI SCHOOL
FACILITY NUMBER: 493010650
VISIT DATE: 07/09/2024
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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.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP)

The following items are required before a license will be issued:

1. Manager approval from Mai Lor
2. An Amended Fire Clearance to reflect the capacity of 60 children.

Exit interview conducted and report was reviewed with the Licensee Representative. The facility representative understands and acknowledges that any advertising for the facility should include their facility (license) number.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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