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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408836
Report Date: 02/22/2024
Date Signed: 02/22/2024 02:33:24 PM


Document Has Been Signed on 02/22/2024 02:33 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:TRUST MONTESSORI SCHOOLFACILITY NUMBER:
434408836
ADMINISTRATOR:LIAO, NINGFACILITY TYPE:
850
ADDRESS:4660 EASTUS DRIVETELEPHONE:
(408) 807-0996
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:232CENSUS: 69DATE:
02/22/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Ning LiaoTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Oscar Huang, conducted conducted an unannounced case management - lead testing/exceedance to the facility. LPA met with Director Ning Liao and informed her of the purpose of the visit. The facility has completed a provider portal at ab2370assistance website on 10/17/2022 which resulted into not eligible (no outlets used for food or drink) to AB 2370 testing requirements for lead in drinking water do not apply to the facility as the facility stated that no water outlets are used for food preparation or drink.

LPA informed licensee that if a facility can establish that they have exclusively used bottled water, and no water outlets or faucets are used for, or made accessible to children to use for, drinking or food preparation, the facility is not required to test for lead pursuant to AB 2370 or the Written Directives.

The facility is encouraged to provide a written statement attesting that the facility has not used and will not used any water outlets for drinking water or food preparation accompanied by a facility map (LIC999) identifying all water outlets located at the facility, and submit them to the office for reviewing and approval.

The written statement may include, but not limited to consider the following questions and provide the answers:

Has the facility provided an LIC 999 facility map indicating that no outlets are subject to testing?
How long have the water delivery services or/and water bottles has been used exclusively?
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024
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: TRUST MONTESSORI SCHOOL
FACILITY NUMBER: 434408836
VISIT DATE: 02/22/2024
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What plan is in place if water delivery is delayed or there is an emergency preventing delivery?
How does the facility ensure that functioning outlets aren't accessible to children and will not be used for drinking water or food preparation?
How does the facility ensure staff and children do not use the water outlets fro drinking water or food preparation?
Are there written policies and procedures or a parent handbook indicates only bottled water is used for food preparation?
Does the parent handbook indicate only bottled water is used for drinking or food preparation?

No deficiencies were cited. A notice of site visit was given and must remain posted for 30 days. The report was discussed during the exit interview with Director, Ning Liao.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC809 (FAS) - (06/04)
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