434407588-4-7-2023-07-CC-AMOS-CQNTGK-20230407144312

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434407588
Report Date: 04/07/2023
Date Signed: 04/07/2023 02:43:21 PM

Document Has Been Signed on 04/07/2023 02:43 PM - 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:	MONTICELLO ACADEMY		FACILITY NUMBER:	434407588
ADMINISTRATOR:	TRINH TRINH		FACILITY TYPE:	850
ADDRESS:	3345 LOCHINVAR AVENUE		TELEPHONE:	(408) 615-9416
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	156	CENSUS: 104	DATE:	04/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rebecca Leung		TIME COMPLETED:	12:45 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 Analysts ( LPA) Anna Morales conducted an unannounced Annual Required inspection. LPA met with Director Rebecca Leung 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 March 31,2023. The Preschool Program is operating in five classrooms. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. 1. Classroom 3: 21 students, three teachers 2. Classroom 4: 20 students, three teachers 3. Classroom 5: 20 students, two teachers 4. Classroom 6: 22 students, two teachers 5. Classroom 7: 21 students, three teachers LPA toured the facility both indoor and outdoor. 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.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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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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: MONTICELLO ACADEMY	FACILITY NUMBER: 434407588
	VISIT DATE: 04/07/2023

NARRATIVE

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Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPA observed play equipment were in good condition. LPA 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 observed that food storage areas were clean and free of litter. 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). Observed centrally stored medications and supporting documentation.

LPA reviewed sign in and out record, and procedure. LPA reviewed a current children's roster. LPA 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 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. LPA 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.

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 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.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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: MONTICELLO ACADEMY	FACILITY NUMBER: 434407588
	VISIT DATE: 04/07/2023

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 26 27 28 29 30 31 32	In the areas that were evaluated, there were no deficiencies cited. A technical violation was issued for two staff who had expired Mandated Reporter Training 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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC809 (FAS) - (06/04)

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