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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406694
Report Date: 03/10/2020
Date Signed: 03/10/2020 01:12:06 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:WAHA MONTESSORIFACILITY NUMBER:
434406694
ADMINISTRATOR:LI, LILIFACILITY TYPE:
850
ADDRESS:220 BLAKE AVENUE #ATELEPHONE:
(408) 247-0286
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:176CENSUS: 53DATE:
03/10/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Lili LiTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Annual inspection of the Preschool and its Toddler Component. LPA met with Director and Administrator Lili Li 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 07:30 AM to 06:00 PM.

LPA inspected the building inside and out. The Preschool operates in Classrooms 15 - 20, A1-A3, and Multipurpose Room. The Toddler Program operates in Classroom 18. 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 smoke detectors, and a fully charged fire extinguisher last serviced on 07/2019. Director stated that the Santa Clara Fire Department has conducted a fire safety inspection this year. Fire/disaster drill log recorded that the last fire drill was conducted on 03/6/2020. The facility does not provides transportation service to children.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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 4
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: WAHA MONTESSORI
FACILITY NUMBER: 434406694
VISIT DATE: 03/10/2020
NARRATIVE
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LPA reviewed facility's sign in and out procedure and record. A sampling of children (9 Children) and staff (8 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, 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.

Incidental Medical Services (IMS) policy was discussed. Director stated that currently there are no children in care who requires IMS. 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.

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoption of new Laws, etc. Beginning January 1, 2019 AB2370 requires licensed centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

In the areas that were evaluated, regulatory violations were observed at the time of the inspection. Exit interview was conducted where this report, the violations, plan of corrections, and appeal rights were reviewed with Director Lili Li.

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 KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: WAHA MONTESSORI
FACILITY NUMBER: 434406694
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2020
Section Cited

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101220(a) 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
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obtain Child 1 and 2 written medical 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.
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Type B
03/27/2020
Section Cited

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1596.7995 HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. [...] The day care center shall maintain documentation of the required
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immunizations. This requirement is not met as evidenced by: Per LPA's review of 8 staff files during the inspection, all 8 staff (Staff 1-8) do not have documented proof that they have immunity against Measles and Perutssis. This poses a potential risk to the health and safety of children in care.
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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 KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: WAHA MONTESSORI
FACILITY NUMBER: 434406694
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2020
Section Cited

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101216(g)(1) PERSONNEL REQUIREMENTS. [...] good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
This requirement is not met as evidenced by:
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Per LPA's review of records during the inspection, facility did not obtain proof that Staff 1, who has been employed for more than 7 days, has a TB clearance. This poses a potential risk to the health and safety of children in care.
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Type B
04/30/2020
Section Cited

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1596.8662(b)(1) MANDATED REPORTER TRAINING. [...] a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years [...].
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This requirement is not met as evidenced by: Per LPA's review of 8 staff files during the inspection, all 8 staff (Staff 1-8) do not have the Mandated Reporter Certification of Completion. Per Director, she was not aware of this requirement. This poses a potential risk to the health and safety of children in care.
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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 KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4