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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408018
Report Date: 05/20/2022
Date Signed: 05/20/2022 04:22:43 PM


Document Has Been Signed on 05/20/2022 04:22 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:MONTESSORI ACADEMY OF CAMPBELLFACILITY NUMBER:
434408018
ADMINISTRATOR:SVETLANA, AMIRFACILITY TYPE:
850
ADDRESS:177 EAST RINCON AVENUETELEPHONE:
(408) 378-9244
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:49CENSUS: 37DATE:
05/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Christina KougiourisTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) James Santos conducted an unannounced Required 1 Year inspection today and met with Licensee, Christina Kougiouris. Director, Svetlana Amir was not at the facility during today's inspection.

LPA toured the center inside and outside with Licensee. The toddler program operates in the green classroom. The preschool programs operate in classrooms red, blue, and purple. The center operates Monday through Friday from 7:30am - 6:00pm.

LPA observed the required posted materials which includes the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule are posted prominently by the entrance area.

The classrooms were observed to be clean and in good order. Furniture and play equipment were observed to be age appropriate and in good condition. Children's restrooms are clean and in good operating condition. Fire extinguishers, smoke and carbon monoxide detectors were observed throughout the facility. Trash cans for solid wastes have tight-fitting covers on. Disinfectants, cleaning solutions and other chemical items and sharp objects are stored and inaccessible to children. Per Licensee, they do not have poisons, weapons and ammunition on the premises.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There are sufficient resilient material in the outdoor playground area. There are no bodies of water observed.

Due to time constraints, the annual inspection will be continued on a later date.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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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