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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408932
Report Date: 03/06/2024
Date Signed: 03/06/2024 02:15:08 PM

Document Has Been Signed on 03/06/2024 02:15 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:MONTESSORI IMPRESSIONS ACADEMYFACILITY NUMBER:
073408932
ADMINISTRATOR:KAUR, JATINDERFACILITY TYPE:
850
ADDRESS:10 RANCH HOUSETELEPHONE:
(925) 765-8473
CITY:ORINDASTATE: CAZIP CODE:
94563
CAPACITY: 21TOTAL ENROLLED CHILDREN: 21CENSUS: 0DATE:
03/06/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jatinder KaurTIME COMPLETED:
02:15 PM
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Centralized Application Bureau (CAB) Licensing Program Analysts (LPAs) M. Domantay and LPA A. Curry met with Applicant Jatinder Kaur for the purpose of a pre-licensing inspection for an application that was submitted for a New Application for a new preschool center. Applicant requests a preschool license to serve 21 preschool children from age two 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 received on 10/5/2023. LPAs confirmed address for facility is: 10 Orinda Fields Lane Orinda, Ca 94563. LPAs notified Applicant that a New LIC200A must be submitted with correct facility address. The facility will provide snacks in the morning and afternoon and lunch will be provided from home.

INDOOR ACTIVITY SPACE:
There are 2 indoor preschool areas: Classroom A and Classroom B. LPAs observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping mats. There is a first aid kit in the Staff Station Area. LPAs notified Applicant of missing items in first aid kit that must be provided. Per Applicant, will obtain sufficient required first aid items and send a photo to LPA to review items are present in the first aid kit. Medications will be stored in the top kitchen cabinets. LPAs observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPAs observed a functional carbon monoxide detector in Classroom A. LPAs observed a fully charged fire extinguisher in Classroom A. LPAs observed a manual sign-in/sign-out system.

LPAs measured all preschool classrooms/areas. The total classroom space contains a total of 754.69 square feet, which will accommodate Applicant's request for 21 preschool children. There is 1 toilet and 1 sinks for the children, and a separate private restroom for the staff is located in the building. Due to number of toilets and sinks in the facility, LPAs notified Applicant facility will be approved with a maximum capacity of 15 children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).
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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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 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: MONTESSORI IMPRESSIONS ACADEMY
FACILITY NUMBER: 073408932
VISIT DATE: 03/06/2024
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Children who become ill during the day will be isolated in the isolation area between the Staff Station Area located between Classroom A and Classroom B and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There are 2 outdoor areas on the property, Outdoor 1 and Outdoor 2. The outdoor play areas is fenced with a metal fence that is at least four feet tall. LPAs observed a sufficient amount of equipment and toys. There is no play structure present in the outdoor play yard areas. LPAs observed 2 sandboxes available for children that were observed to be maintained, free of clutter, and have sufficient covering. There are no bodies of water on the premises. There is sufficient outdoor shading provided by trees and tarp.

LPA measured the outdoor activity space. The outdoor play area contains a total of 6023.61 square feet, which will accommodate Applicant's request for 21 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.

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.


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

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
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: MONTESSORI IMPRESSIONS ACADEMY
FACILITY NUMBER: 073408932
VISIT DATE: 03/06/2024
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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, Jatinder Kaur.

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

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

2. Updated LIC200A with correct facility address and must provide original document.

3. Applicant must provide photos of required sufficient items in the facility first aid kit.

Page 3

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

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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