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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407588
Report Date: 07/07/2021
Date Signed: 07/08/2021 08:18:14 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:MONTICELLO ACADEMYFACILITY NUMBER:
434407588
ADMINISTRATOR:TRINH TRINHFACILITY TYPE:
850
ADDRESS:3345 LOCHINVAR AVENUETELEPHONE:
(408) 615-9416
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:156CENSUS: 67DATE:
07/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Trinh TrinhTIME COMPLETED:
12:45 PM
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(#1) Licensing Program Analysts ( LPA's) Anna Morales and Joe Macias conducted an unannounced Annual Required inspection. LPAs met with Director, Trinh Trinh at today's inspection. Facility's License, Notification of Parents’ Rights Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 7:00am--6:00pm. Age serve is 2 years to entry into Pre-K. Last disaster drill was conducted on June 7, 2021.

The Preschool Program is operating in five classrooms. LPAs toured the facility both indoor and outdoor. LPA's observed that the facility was operating in compliance with teacher to children ratio requirement. LPA 's observed nine teachers and a total of 67 children. Children were engaged in activities. There were no bodies of water observed. Director stated that facility do not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean.

Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPAs observed play equipment were in good condition. LPA's observed resilient materials under the climbing structures. Drinking water was readily available to children indoor and outdoor. Activities schedule and Menu were posted. Facility provides breakfast, lunch and two snacks (morning and afternoon). LPA's observed that food storage areas were clean and free of litter.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
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: MONTICELLO ACADEMY
FACILITY NUMBER: 434407588
VISIT DATE: 07/07/2021
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Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher, smoke and carbon monoxide detectors were observed. The fire alarms and smoke detectors are hardwired.

This facility is providing Incidental Medical Services – IMS Plan. There is a Nurse on grounds and a Nurses Station for children who require medication. The Nurses station is also is being used for Isolation (if a child gets sick while at the center) or in the front of the center( outside). None of the children currently enrolled are using medication.

LPAs reviewed sign in and out record, and procedure. LPA's reviewed a random selection of children files. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, Immunization.

LPA's reviewed a random selection of Staff records reviewed include Criminal Record and Child Abuse Index Clearance, Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. LPAs reminded Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. All There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPAs 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 per day 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.

LPAs also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC809 (FAS) - (06/04)
Page: 3 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: MONTICELLO ACADEMY
FACILITY NUMBER: 434407588
VISIT DATE: 07/07/2021
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In the areas that were evaluated, there were no deficiencies cited.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3