434408804-10-14-2021-52-CC-MESA-C7SQKC-20211014121408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408804
Report Date: 10/14/2021
Date Signed: 10/14/2021 12:51:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GOLDEN HARVEST MONTESSORI SCHOOL		FACILITY NUMBER:	434408804
ADMINISTRATOR:	ALI, KIMBERLY		FACILITY TYPE:	850
ADDRESS:	1905 NORTH MILPITAS BOULEVARD		TELEPHONE:	(408) 719-1686
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	80	CENSUS: 48	DATE:	10/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kimberly Ali		TIME COMPLETED:	01:00 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 Thursday, October 14, 2021 at 9 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required one (1) Year Visit. LPA met with the Director Kimberly Ali and explained the nature of the site visit. Present on this visit were 10 staff and 48 preschool children. Facility operates from Monday to Friday 8am to 6pm. LPA toured the facility to conduct a Health and Safety Inspection with the Director. The facility has four classrooms utilized for the preschool program. The rooms Junior Adventure and Racketeer are located next to facility's Main Entrance and adjacent to the fenced front yard facing the street. The rooms Cosmos and Shooting Star and Nebula are located next to the play yard. All classrooms were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces, the presence of working carbon monoxide detector, smoke detectors/fire alarms and a fully charged fire extinguishers size that is accessible throughout the facility. The facility's Fire Department Permit expiration date is 12/31/2021. The outdoor play area is fully fenced. There is padding under/around the climbing equipment. The play structures appear to be fully intact with no visual defects or concerns. There are no pools, hot tubs or other accessible bodies of water. Per the Director, there are no firearms present on the premises. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. The children brings their own lunch and snacks, and facility serves them as needed. The center also conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on July 2021. A copy of the facility personnel roster and children’s roster were available for review and copy was obtained. Daily Sign In and Out for the staff and children are electronically done through Procare app and LPA obtained copies of Sign In and Out for this week. SEE 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GOLDEN HARVEST MONTESSORI SCHOOL	FACILITY NUMBER: 434408804
	VISIT DATE: 10/14/2021

NARRATIVE

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LPA reviewed the file of 12 children enrolled in the program and 6 staff members files, who are fingerprint cleared, completion of Mandated Reporter training as well as proof of immunization's. All staff have current CPR/First Aid certificates, and proof of education and/or experience was also present. Staff interview also conducted and documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the following;

PIN 21-21-CCP RELEASE OF THE WRITTEN DIRECTIVES FOR LEAD TESTING OF

WATER IN LICENSED CHILD CARE CENTERS PER AB 2370, Lead PUB 515 and Lead Poisoning Prevention Training. Childcare Resource & Referral Program - Santa Clara County Office of Education 669-212-KIDS (5437) and childcarescc@sccoe.org

SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GOLDEN HARVEST MONTESSORI SCHOOL	FACILITY NUMBER: 434408804
	VISIT DATE: 10/14/2021

NARRATIVE

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For questions about registration or your stipend, please call 1-833-398-1399 Hours of operation are 6:00am – 6:00pm CST

Facility representative was reminded of the responsibility as a mandated reporter and the training's must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged facility representative to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Report (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Directo Kimberly Ali.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021

LIC809 (FAS) - (06/04)

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