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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700667
Report Date: 12/06/2024
Date Signed: 12/06/2024 06:40:22 PM

Document Has Been Signed on 12/06/2024 06:40 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 SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LEARN AND PLAY MONTESSORI DUBLINFACILITY NUMBER:
015700667
ADMINISTRATOR/
DIRECTOR:		GABRIELA ARRIZONFACILITY TYPE:
860
ADDRESS:3960 SUMMIT RDTELEPHONE:
(510) 916-1503
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 205TOTAL ENROLLED CHILDREN: 205CENSUS: 103DATE:
12/06/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Natasha AguilarTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Senior Director Natasha Aguilar for the purpose of a pre-licensing change of ownership inspection. Applicant requests a toddler component for 24 toddlers ages 18-36 months, a preschool component for 140 preschool children ages two years to entry into TK, and a school-age component for 41 school-age children ages TK to nine years old for a total capacity of 205. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance was granted and received on 10/2/2024. The facility will provide morning and after snack.

LPA informed Senior Director that the facility will be converted to a single child care center license under facility number 015700667, therefore LPA will be closing the current preschool and school-age facility numbers 015700617/015700618.

LPA reviewed with Senior Director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed the safe sleep regulations with Senior Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Senior Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Report continues on LIC809-C page 2.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEARN AND PLAY MONTESSORI DUBLIN
FACILITY NUMBER: 015700667
VISIT DATE: 12/06/2024
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Page 2.

INDOOR ACTIVITY SPACE:
There are two toddler classrooms located in Toddler Classrooms 1A & 1B, four preschool classrooms located in Preschool Classrooms #2, #3, #4, & #5, and two school-age classrooms located in School-age Classrooms 6A & 6B. LPA observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in each of the classrooms. Medications will be stored in the office. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Senior Director stated there are no poisons or firearms on the premises. LPA observed water fountains in each of the classrooms. LPA observed a functional carbon monoxide detector in each classroom. LPA observed an electronic sign-in/sign-out system.

LPA measured Toddler Classrooms 1A & 1B. The total classroom spaces contain a total of 910 square feet, which will accommodate applicant's request for 24 toddlers. There are three toilets and fives sinks for the children. LPA measured Preschool Classrooms #2, #3, #4, & #5. The total classroom spaces contain a total of 4,922 square feet, which will accommodate applicant’s request for 140 preschool children. There are eight toilets and twelve sinks for the children. LPA measured School-age Classrooms 6A & 6B. The total classroom spaces contain a total of 1,573 square feet, which will accommodate applicant’s request for 41 school-age children. There are three toilets and five sinks for the children. There is two additional sinks and one toilet located in the preschool yard. There is a separate private restroom for the staff located in the front lobby. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There are two outdoor areas on the property, Toddler Playground and Preschool/School-age Playground. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall and separates the preschool/school-age yard from the toddler yard.

Report continues on LIC809-C page 3.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEARN AND PLAY MONTESSORI DUBLIN
FACILITY NUMBER: 015700667
VISIT DATE: 12/06/2024
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Page 3.

Applicant has requested a Shared Outdoor Space Waiver for the preschool and school-age components and an Insufficient Outdoor Space Waiver for the preschool yard and toddler yard. LPA observed a sufficient amount of equipment and toys. The play structure includes a safety label, which designates use for children 2 to 12 years old. There are no bodies of water on the premises. There are shaded areas supplied by overhangs on both yards and a large canopy of the preschool yard.

LPA measured the toddler outdoor activity space. The outdoor play area contains a total of 1,196 square feet, which will only accommodate 15 toddlers. LPA measured the preschool/school-age outdoor activity space. The outdoor play area contains a total of 5,604 square feet, which will only accommodate 74 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 Senior Director 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 continues on LIC809-C page 4.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEARN AND PLAY MONTESSORI DUBLIN
FACILITY NUMBER: 015700667
VISIT DATE: 12/06/2024
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Senior Director 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.

Senior Director 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.

Written Directives for Lead Testing in Child Care Centers: Assembly Bill 2370, Chapter 676, Statutes of 2018, added Health and Safety Code section 1597.16 requiring all licensed Child Care Centers constructed before January 1, 2010, test their water for lead between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing. For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

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.

Report continues on LIC809-C page 5.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LEARN AND PLAY MONTESSORI DUBLIN
FACILITY NUMBER: 015700667
VISIT DATE: 12/06/2024
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Page 5.

Exit interview conducted and report was reviewed with the Senior Director Natasha Aguilar.

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

1. Shared Outdoor Space Waiver for preschool and school-age review.

2. Insufficient Outdoor Space Waiver for toddler and preschool review.

3. Director qualifications review.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5