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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700555
Report Date: 12/02/2022
Date Signed: 12/02/2022 03:20:53 PM

Document Has Been Signed on 12/02/2022 03:20 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LEVEL UP MONTESSORI - HAYWARDFACILITY NUMBER:
015700555
ADMINISTRATOR:GANESAN, SUNDARIFACILITY TYPE:
850
ADDRESS:31145 MISSION BOULEVARDTELEPHONE:
(408) 431-7003
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 38DATE:
12/02/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sandhya AgarwalTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Melanie Otsuji conducted an unannounced Case Management - Licensee Initiated inspection on today's date, 12/02/2022. LPA was met by Applicant, Sandhya Agarwal. Present during today's visit were 38 preschool aged children and 6 staff members. The center has submitted an application for a CAPACITY DECREASE to the PRESCHOOL COMPONENT. PRESCHOOL COMPONENT is currently requesting to decrease from 90 preschoolers to 78 preschoolers which includes the option to have up to 18 toddlers (18 months- 36 months) participating in the toddler option program. A health and safety inspection was conducted inside and outside. Facility days and hours of operation are Monday through Friday 7:30AM - 6:00PM. The facility measurement is as follows:

INDOORS: 2735.12 SQUARE FEET = 78 CHILDREN
OUTDOORS: 3372.24 SQUARE FEET = 45 CHILDREN

The center has obtained an approved fire clearance from Hayward Fire Department for 78 preschool aged children which includes the option to have up to 18 toddlers. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 7 toilets, and 7 sinks available for children use.

The classrooms and play yard are age appropriate and in good repair. Bathrooms are clean and in working order. The staff have a separate bathroom located within the facility.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEVEL UP MONTESSORI - HAYWARD
FACILITY NUMBER: 015700555
VISIT DATE: 12/02/2022
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Facility representative was reminded that all adults 18 and over, 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.

Director is reminded that unusual Incidents must be reported within 24 hours by phone. Written report is to follow within 7 days utilizing form LIC624. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

An exit interview was conducted with the Applicant, Sandhya Agarwal. No citations issued during today's visit. Effective today Preschool Component will decrease from 90 preschoolers to 78 preschoolers (operating in Purple, Orange, Green, and White Rooms) which includes the option to have up to 18 toddlers in the toddler option classroom (White Room A/B). A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC809 (FAS) - (06/04)
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