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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846137
Report Date: 04/20/2023
Date Signed: 04/20/2023 12:22:22 PM

Document Has Been Signed on 04/20/2023 12:22 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTESSORI ACADEMY OF UPLANDFACILITY NUMBER:
364846137
ADMINISTRATOR:THEWES, ADAMFACILITY TYPE:
840
ADDRESS:934 N MOUNTAIN AVE, SUITE GTELEPHONE:
(909) 621-1603
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
04/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Adam ThewesTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA), Samuel Lopez arrived at the facility to conduct a Case Management inspection due to the request submitted for a room change. The current room being utilized by the School Age program will be added to the Preschool Program. The School Age program will now operate in a new room, with the same assigned number, E1, and is to remain with the same capacity of 30. A Fire Clearance was granted on 4/11/2023.

The days and hours of operation will remain the same: Monday through Friday; 6:30am to 6:30pm.

LPA Lopez toured the facility and measured the room that will now be assigned to the School Age Program. Based on the measurements taken, the following was determined:

School-Age Indoor Activity Areas
LPA has determined that there is sufficient space to accommodate 31 children.

School-age Bathroom Fixtures
2 toilets x 15 = 30 children
3 sinks x 15 = 45 children

School-Age Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 147 children.
*There is a waiver on file due to the School Age and Private School programs sharing the outdoor activity space*

Limiting factor for school-age capacity is the Fire Clearance granted.
School-age capacity is limited to 30 children.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MONTESSORI ACADEMY OF UPLAND
FACILITY NUMBER: 364846137
VISIT DATE: 04/20/2023
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The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Filtered water supply drinking water in the indoor activity space
· Playgrounds are enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
· There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· An adequate amount of cushioning material (wood chips) is in place under play equipment
· Adequate shade is provided
· Drinking water is provided in the outdoor play areas by personal cups filled with filtered water
· Toxins are locked
· The Director/Facility Representative/Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· A review of staff records on 4/20/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MONTESSORI ACADEMY OF UPLAND
FACILITY NUMBER: 364846137
VISIT DATE: 04/20/2023
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No cited deficiencies during today's inspection

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Room change to be submitted for approval.

Exit interview conducted and report was reviewed with the Director/Licensee Adam Thewes
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
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