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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407563
Report Date: 09/09/2021
Date Signed: 09/09/2021 11:34:25 AM

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:ABC LEARNING MONTESSORIFACILITY NUMBER:
434407563
ADMINISTRATOR:DIANA MANIXFACILITY TYPE:
850
ADDRESS:1115 KIMBERLY DRIVETELEPHONE:
(408) 448-4578
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:49CENSUS: 30DATE:
09/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Diana ManixTIME COMPLETED:
11:50 AM
NARRATIVE
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Licensing Program Analysts, Oscar Huang conducted a Case Management Visit and was greeted by Center Director Diana Manix. The purpose for this visit was in response of an Incident that was reported by the facility. The incident occurred on 8/31/2021 where a child while opening the bathroom door, not knowing the bathroom was occupied by another child who then closed the door caused to hurt her pinky finger approximately around 4:40pm when the whole group came in from outdoor play, and staff were helping children in other bathrooms washing their hands.

LPA conducted interviews with Director Diana and two teachers who were present when the incident occurred. LPA's, also, toured the classroom and the bathrooms. LPA observed a stopper was installed on every bathrooms' door to prevent the door to be completely closed.

On 8/31/2021, there were seven children in the same group supervised by two teachers in line-up of a bathroom to help washing their hands. During that time, one child ran to the other bathroom for pee unnoticed, an other child later went as well.

California Code of Regulations, (Title 22, Division 12 & Chapter 1), is being cited on the attached LIC 809D. Copy of appeal rights provided to Director Diana Manix.
A notice of site visit was issued and is to be posted near the facility entrance along with the Type "B" deficiency issued today and must remain posted for 30 consecutive days.

Exit Interview was conducted with Director. Appeal Rights given
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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: ABC LEARNING MONTESSORI
FACILITY NUMBER: 434407563
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2021
Section Cited

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Responsibility for Providing Care and Supervision: No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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This was not met by: LPA learnt that two children left the line and went to bathroom without being visual observed. This presents a potential risk to the health/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: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2021
LIC809 (FAS) - (06/04)
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