434404906-2-19-2020-07-CC-TDON-BLXTGW-20200219134348

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404906
Report Date: 02/19/2020
Date Signed: 02/19/2020 01:43:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	APPLESEED MONTESSORI SCHOOL		FACILITY NUMBER:	434404906
ADMINISTRATOR:	VENTER, MICHAELLA		FACILITY TYPE:	850
ADDRESS:	1302 WARNER AVENUE		TELEPHONE:	(408) 245-7338
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	96	CENSUS: 62	DATE:	02/19/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Michaella Venter		TIME COMPLETED:	01:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Annual inspection of the Preschool and its Toddler Component. LPA met with Director Michaella Venter and explained to her the purpose of the inspection. Facility's License, Notification of Parents’ Right Poster, Children's Personal Rights, and Child Car Seat Law were observed to be posted. Facility operates Monday through Friday from 07:00 AM to 06:00 PM. LPA inspected the building inside and out. The Preschool operates in Classrooms: 1, 2, and 3. The Toddler Program operates in Classroom 4a and 4b. The classrooms, Office area, children restrooms, staff restroom, director's office, and food storage areas were inspected. Furniture and equipment were observed to be age appropriate and in good condition. Restrooms for children to use were observed to be in operating condition. Floors were clean. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides two snacks a day. Snack menu was posted. Food are stored in the Kitchen. Trash can for solid waste had tight fitting covers on. Outdoor activity space was enclosed by fence. The Toddler outdoor activity space is physically separated from the Preschool outdoor activity space. LPA observed play equipment were maintained in a good condition, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Director stated that facility does not have weapons on the premises. Drinking water was arranged to be readily available to children. Shade is provided by trees, canopy, and building overhang. LPA observed that facility has a fire sprinkler system, fire alarm system, smoke and carbon monoxide detectors, and a fully charged fire extinguisher last serviced on 04/2019. Fire/disaster drill log recorded that the last fire drill was conducted on 02/14/2020. The facility does not provides transportation service to children.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: APPLESEED MONTESSORI SCHOOL	FACILITY NUMBER: 434404906
	VISIT DATE: 02/19/2020

NARRATIVE

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LPA reviewed facility's roster, and sign in and out procedure and record. A sampling of children (25 Children) and staff (6 Staff) files was selected for review. Children record reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, immunization, and needs and services plans for children under 2 years old. Staff records reviewed include Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one staff present with current Pediatric CPR/1st Aid certification.

LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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 also reviewed with Director the violations that would result in an immediate $500 civil penalty assessment. Facility is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations etc.

In the areas that were evaluated, one regulatory violation was observed at the time of the inspection. Exit interview was conducted where this report, the violation, plan of correction, and appeal rights were reviewed with Director Michaella Venter.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: APPLESEED MONTESSORI SCHOOL	FACILITY NUMBER: 434404906
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/19/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/04/2020 Section Cited	1 2 3 4 5 6 7	CHILD'S MEDICAL ASSESSMENT. Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This requirement is not met as evidenced by: Per LPA's review of files, Licensee did not obtain Child 1's written medical assessment,
	8 9 10 11 12 13 14	and Child 2's Tuberculosis risk assessment. Both children have been enrolled for more than 30 days. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

LIC809 (FAS) - (06/04)

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