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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010677
Report Date: 08/22/2024
Date Signed: 08/22/2024 11:56:12 AM

Document Has Been Signed on 08/22/2024 11:56 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:WATERSHED MONTESSORI SCHOOLFACILITY NUMBER:
493010677
ADMINISTRATOR/
DIRECTOR:		BURCHETT, RICHARDFACILITY TYPE:
860
ADDRESS:1569 BRUSH CREEK ROADTELEPHONE:
(707) 494-4910
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 0DATE:
08/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Richard BurchettTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 08/22/2024, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat and LPA Amy Strother met with the Licensee Representative Richard Burchett for the purpose of an announced pre-licensing inspection. The Applicant requests the following components for their program: A Toddler component which will serve 12 toddlers ages 18-36 months and a Preschool component which will serve 24 children ages 2 years to entry into first grade.

The program will operate 7:30 AM - 5:30 PM Monday through Friday. The fire clearance was granted on 07/15/2024 by the Sonoma County Fire District. During this visit, LPAs Manabat and Strother and the applicant reviewed the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, Menus, and Daily schedule. Applicant stated that the facility serves and prepares AM and PM snack, raw ingredients are brought in from the children's families, and lunch will be provided via the children's families.

INDOOR ACTIVITY SPACE:
During the inspection, LPAs observed 4 rooms in the facility. The first two rooms are utilized by the toddler program and are located in a stand-alone building that is located on the west end of the premises, currently called the Kingfisher room. There is a main education room and a nap room that are connected via a door. In the toddler area, LPAs observed a sufficient amount of age-appropriate equipment, toys, tables, and cubbies. There is a first aid kit located in the education/main room. The second set of rooms is designated for preschool. The first of the preschool rooms is located in the Heron building which is adjacent to the preschool play yard. The second of the preschool rooms is located in the office/nest building and is primarily utilized for nap time for the preschool program. LPA Manabat documented measurements for all classrooms. (Report continued on subsequent LIC 809)
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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: WATERSHED MONTESSORI SCHOOL
FACILITY NUMBER: 493010677
VISIT DATE: 08/22/2024
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PAGE 2
A total of: 726.42 square feet was measured for the toddler main education space and the nap room was 414.0 square feet was measured for the toddler nap room.

A total of 1,650.95 total square feet was measured for the main preschool room in the Heron building and 450.06 square feet for the preschool nap room in the office/nest building. These measurements indicate that there is enough space to accommodate for the 12 toddlers and 24 preschoolers.

In the toddler room there is a total of 2 sinks and 1 changing table. During today's visit, LPAs discussed the distance from the changing table to the available sink. LPAs advised that the changing table would need to be in arms reach of a sink. The facility representative stated that they would be placing a changing mat inside of the bathroom so that it is within arms reach. The facility representative stated that they would provide LPAs with a picture of the changing mat inside of the bathroom.

In the preschool room, there are a total of 2 toilets that are located within the heron building/classroom, 2 sinks located indoors, and 4 sinks that are located outside (6 sinks in total). For all components, the number of toilets and sinks will accommodate the facility's requested capacity. There are two private restrooms for the staff located both inside of the Toddler room and the heron building. It was stated that any child(ren) who become ill during the day will be isolated in the office area and will utilize the staff restrooms. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The Facility Representative stated that medications are stored in classrooms and will be inaccessible to children. The facility representative stated there are no firearms or bodies of water on the premises. Indoor and outdoor drinking water will be provided via water jug filters and water bottles. LPAs observed and tested each building's carbon monoxide detector. According to the Facility Representative, the sign-in/sign-out system is on paper sheets.


(Report continued on subsequent LIC 809)
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
Page: 2 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: WATERSHED MONTESSORI SCHOOL
FACILITY NUMBER: 493010677
VISIT DATE: 08/22/2024
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PAGE 4:
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

Facility Representatives 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.

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.

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.
Exit interview conducted and report was reviewed with the Applicant.

The following item is required before a license will be issued:

1. Manager approval by a Licensing Program Manager.


2. Photos of the changing mat inside of the toddler room.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
Page: 4 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: WATERSHED MONTESSORI SCHOOL
FACILITY NUMBER: 493010677
VISIT DATE: 08/22/2024
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PAGE 3: OUTDOOR ACTIVITY SPACE:
During today's visit, LPAs observed a total of three separated outdoor yards on the site. There is one outdoor yard on site that is immediately connected to a building that is currently not in use. This is the yard that is mainly located near the center of the premises. LPAs observed the yard but noted that the current fencing around that yard does not meet fencing requirements. It was discussed that if the facility wanted to use this yard that they would need to contact licensing prior to any changes to yard use and ensure that the fencing complies with regulations.

The toddler component will be utilizing two different yards on the property. The first toddler yard is connected immediately to the back of the toddler building. In this yard there currently exists one sandbox structure and several metal planter boxes; no play structure was observed in this yard. LPAs noted that there is a sufficient amount of shade that is provided via trees and sides of the building. This yard is fenced with a chain-linked fence that meets regulations. The second toddler yard is located within the preschool main yard and is appropriately fenced with wire/dense metal fencing. This toddler yard contains swings and is lined with wood chip substrates. There is no play structure in this section of the yard.

The preschool yard is located immediately outside of the Heron building and does have a play structure. It was noted that the play structure is suitable for ages 2-5. LPA Manabat observed that the play yard is shaded via trees and canopies. LPA Manabat observed a sufficient amount of age appropriate equipment and toys for all outdoor play areas.

OUTDOOR ACTIVITY MEASUREMENTS:
LPA measured a total of 2,882.25 total square feet for the toddler outdoor space and 8,331.41 square feet in the preschool yard. These measurements indicate that the outdoor play spaces will accommodate the Applicant's request for 12 toddlers and 24 preschoolers .

LPAs discussed the following: 100% supervision is required at all times; 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.
(Report continued on subsequent LIC 809)
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
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