434407563-12-11-2023-07-CC-FRAA-CYENKL-20231211093207

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407563
Report Date: 12/08/2023
Date Signed: 12/11/2023 09:32:17 AM

Document Has Been Signed on 12/11/2023 09:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	ABC LEARNING MONTESSORI		FACILITY NUMBER:	434407563
ADMINISTRATOR:	DIANA MANIX		FACILITY TYPE:	850
ADDRESS:	1115 KIMBERLY DRIVE		TELEPHONE:	(408) 448-4578
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	49	CENSUS: 28	DATE:	12/08/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:09 PM
MET WITH:	Sharzad Otmishi		TIME COMPLETED:	06:00 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	On 12/08/2023 at 1:09pm, Licensing Program Analyst (LPA), Farida Raja, arrived to conduct an unannounced Required 3-Year inspection in the preschool program. LPA was granted entry into the facility by teacher, Giovana Tinoco and explained the nature of today's inspection. Teacher stated that the director was on vacation and designated teacher/facility representative was on lunch and will arrive soon. Teacher, Sharzad Otmishi arrived at 2:35pm and LPA explained the purpose of the visit. The facility is licensed to serve children ages 2-6 years in three rooms. The facility has one waiver on file for shared outdoor playground space. LPA observed the required posted materials near the front entrance and menus and daily activity schedule in each classroom. Days and hours of operation are Monday through Friday, 7:00 am to 6:00 pm. LPA toured the indoor and outdoor areas of the facility. Children were combined for nap time in the 2-year old room. LPA observed 1 teacher and 7 children in one section of the room and 21 children and 1 teacher in the other. Facility was in compliance with teacher to children ratio requirement. The classrooms, children's restrooms, staff restroom and kitchen were inspected. Facility has central heating/cooling for comfort of children. Facility representative states that there are no weapons or firearms on the premises. There is a working telephone at the facility (408-448-4578). Disinfectants and cleaning products were stored inaccessible to children. Medications are stored in a locked closet near the kitchen area. All cabinets and rooms used for storage were child locked/gated. Furniture and equipment were age appropriate and free of sharp, loose, or pointed parts. Floors were clean and free from tripping hazards. LPA observed appropriate changing table in the 2-yr old room. Napping mats were appropriate. LPA observed solid waste containers with tight-fitting lids in the rooms. Restrooms and sinks for children were observed to be safe and in working condition. Staff has one separate bathroom that can be utilized by sick children if needed. Continued on Page 2

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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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Document Has Been Signed on 12/11/2023 09:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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: 12/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type A

Section Cited

CCR

101170(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	(2) Request a transfer of a criminal record clearance as specified in Section 101170(f) Based on observation, interview and record review, the licensee did not comply with the section cited above for staff, S4, which poses an immediate health, safety or personal rights risk to persons in care. LPA observed staff, S4, working with children but without having fingerprint clearance transferred to this facility.
	POC Due Date: 12/09/2023
	Plan of Correction
1 2 3 4	Director will submit a written plan of correction to LPA by 12/09/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/11/2023 09:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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: 12/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(c)

101217 Personnel Records (c) All personnel records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above all staff, which poses a potential health, safety or personal rights risk to persons in care. Facility representative did not have access to personnel records in the absence of the director at the facility.
	POC Due Date: 12/22/2023
	Plan of Correction
1 2 3 4	Director will submit a plan of correction to LPA by 12/22/2023.

Type B

Section Cited

CCR

101221(d)

101221 Child's Records (d) All children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above all children in care, which poses a potential health, safety or personal rights risk to persons in care. Facility representative did not have access to children's records in the absence of the director at the facility.
	POC Due Date: 12/22/2023
	Plan of Correction
1 2 3 4	Director will submit a plan of correction to LPA by 12/22/2023.

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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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

FACILITY NAME: ABC LEARNING MONTESSORI	FACILITY NUMBER: 434407563
	VISIT DATE: 12/08/2023

NARRATIVE

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LPA observed one fire extinguisher in the kitchen, working smoke and carbon monoxide detectors, and fire pull stations. Facility representative did not have access to the fire drill log, water lead testing report, personnel records and children's records.

Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles and water fountains. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Facility provides breakfast and afternoon snack. Parents provide lunch for the children. Foods and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration are stored in covered containers.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has sufficient artificial grass as resilient materials to absorb falls. Areas around and under high climbing equipment and slides were cushioned with rubber mats. Shaded rest area is provided by one large canopy, and building overhang. There were no bodies of water observed.

Children sign in and out procedures and logs were reviewed. On review of staff roster, LPA observed that Staff, S4, is not associated/had fingerprint clearance transferred to this facility. At 3:42pm, LPA spoke with Director, Diana Manix, via phone. Based on interview with director, she stated that staff's (S4) fingerprint clearance was not transferred to this facility. Facility Representative and Director was reminded that all adults 18 and over, 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.

Continued on Page 3

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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

FACILITY NAME: ABC LEARNING MONTESSORI	FACILITY NUMBER: 434407563
	VISIT DATE: 12/08/2023

NARRATIVE

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Facility representative stated that facility does handle medications and currently has children in care who require Incidental Medical Services and LPA observed the medication is properly stored out of reach of children. LPA was unable to review parent authorization forms due to facility representative not having access to children's records. Facility has an approved IMS Plan on file with San Jose Regional Office. For IMS information see PIN 22-02-CCP. Isolation of sick child was discussed, facility representative stated that sick children will be isolated in a different area of the classroom, away from the other children and isolation equipment will be provided. A staff restroom which is off limits to other children is used if necessary. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Facility does not provide transportation to children. Facility Representative was informed of the MyChildCarePlan.org website; 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

One Type A and two Type B deficiency was cited today on the attached LIC 809D pages. Appeal rights and LIC 9224 were printed and given to Director. Due to the issuance of a Type A Citation, a copy of this Licensing Report must be given to each existing parent by the end of today or next day child is in care, and to any newly enrolled parents/guardians enrolled over the next 12 months from the date of this report. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file. LPA reminded Director that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation.

Exit interview conducted and report was reviewed via phone with director, Diana Manix and Teacher/Facility Representative, Sharzad Otmishi.
A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC809 (FAS) - (06/04)

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