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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409594
Report Date: 07/29/2024
Date Signed: 07/29/2024 02:04:05 PM

Document Has Been Signed on 07/29/2024 02:04 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LEARN AND PLAY MONTESSORI HERCULES INCFACILITY NUMBER:
073409594
ADMINISTRATOR/
DIRECTOR:		LIZETTE SUAREZFACILITY TYPE:
860
ADDRESS:1702 PHEASANT DRTELEPHONE:
(510) 941-0102
CITY:HERCULESSTATE: CAZIP CODE:
94547
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 0DATE:
07/29/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Natasha AguilarTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On Monday, July 29, 2024 Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) M. Domantay met with Applicant Natasha Aguilar for the purpose of a pre-licensing inspection. Applicant requests a preschool license to serve 105 preschool children from age two years to first grade entry. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance was granted and approved on 4/3/2024 from the Rodeo-Hercules Fire Department. The facility will provide 1 morning snack and 1 afternoon snack, and lunch will be provided from home.

LPA 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 7 preschool areas: Classroom 1, Classroom 2, Classroom 3, Classroom 4, Activity Area 1, Activity Area 2, and Activity Area 3. LPA observed sufficient amount of equipment, toys, tables, chairs, and mats during today's inspection. LPA observed a first aid kit available in Classroom 1, located on the wall. Medications will be stored in the office entrance/reception area in a locked drawer. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPA observed a functional carbon monoxide detector in the facility in Classroom 1. Per Applicant facility will utilize electronic sign-in/sign-out system.

LPA measured all preschool classrooms/areas. The total classroom space contains a total of 3634.84 square feet, which will accommodate Applicant's request for 105 preschool children. There are 9 toilets, 1 urinal, and 11 sinks for the children, and a separate private restroom for the staff is located in the hall of the facility. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office entrance/reception area and will use the staff restroom, if necessary. Page 1
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LEARN AND PLAY MONTESSORI HERCULES INC
FACILITY NUMBER: 073409594
VISIT DATE: 07/29/2024
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OUTDOOR ACTIVITY SPACE:
There is 1 preschool outdoor area. The outdoor play area is fenced with a metal wire fencing that is at least four feet tall. There are play structures in the preschool play yard with manufacturer sticker stating play structure is for children 2-12 years of age. Play structures are filled with tan bark and rubber matting as cushioning to cushion a child's fall. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. LPA reminded Applicant to ensure to empty all water tables when not in use. There is sufficient shading areas provided by canopies in the preschool play yard.

LPA measured the outdoor activity space. The Preschool outdoor play area contains a total of 8742.77 square feet, which will accommodate Applicant's request for 105 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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

LPA 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. LPA 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.

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LEARN AND PLAY MONTESSORI HERCULES INC
FACILITY NUMBER: 073409594
VISIT DATE: 07/29/2024
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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.

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 Applicant, Natasha Aguilar.

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

1. Licensing Program Manager (LPM) final file review.

Page 3

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
LIC809 (FAS) - (06/04)
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