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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010437
Report Date: 08/29/2023
Date Signed: 08/29/2023 01:42:07 PM

Document Has Been Signed on 08/29/2023 01:42 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:FAIRFIELD MONTESSORIFACILITY NUMBER:
483010437
ADMINISTRATOR:KUMAR, UMA DEVIFACILITY TYPE:
850
ADDRESS:1101 UTAH STREETTELEPHONE:
(707) 427-1442
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 8DATE:
08/29/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Monika VermaTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with applicant Monika Verma who has purchased the Fairfield Montessori Child Care Center. The operations have continued during this change of ownership. The application was received on May 16, 2023. The fire clearance was approved on June 5, 2023. The staff will remain employees with the new owner.

The facility has three main classrooms for different activities. The main center room is the location for the sign in and sign out form. There is sufficient interior square footage to support 34 preschool children. There is an office/staff room and a staff toilet. There is also sufficient furniture, equipment, toys and materials for the children. There are three toilets and three sinks for the children to use. There are functioning carbon monoxide and smoke detectors as well as a fire extinguisher rated at least 2A10BC.
First aid supplies must be maintained and present in the facility at all times.

The outdoor activity area has sufficient square footage for the 34 children. The activity area is fully fenced with a large amount of shade from trees and a pergola. There are age appropriate equipment, toys and benches for outdoor dining. The children will use individual water bottles for hydration.

The 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.

This facility plans to provide Incidental Medical Services in the future – 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.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: FAIRFIELD MONTESSORI
FACILITY NUMBER: 483010437
VISIT DATE: 08/29/2023
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LPA reviewed with [applicant, licensee, or facility representative] 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 [applicant, licensee, or facility representative] 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 [applicant, licensee, or facility representative] 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.

The 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 platforms. 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.

A notice of site visit will be given to a facility representative for any visit other than a prelicensing visit and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

The lead water testing was completed under the prior license. The new owner may ask for a waiver to use the prior licensee's lead testing results until the next lead testing is required.

The facility is approved for licensure for 34 preschool age children effective August 29, 2023.

Exit interview conducted and report was reviewed with the licensee, Monika Verma
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC809 (FAS) - (06/04)
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