434412135-7-30-2021-07-CC-YHUG-C5EPEP-20210730111528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412135
Report Date: 07/30/2021
Date Signed: 07/30/2021 11:16:24 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:	EMPIRE MONTESSORI PRESCHOOL BILINGUAL-CHINESE		FACILITY NUMBER:	434412135
ADMINISTRATOR:	SHIMEI YANG		FACILITY TYPE:	850
ADDRESS:	3095 YERBA BUENA ROAD		TELEPHONE:	(408) 238-7300
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	103	CENSUS: 21	DATE:	07/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Shimei Yang & Caroline Dino		TIME COMPLETED:	11:45 AM

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 Analyst (LPA) Oscar Huang conducted an unannounced Annual Required inspection. LPAs met with Licensee, Shimei Yang & Director, Caroline Dino 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 8:00am--5:00pm. Age serve is 2 years to entry into first grade entry. The facility conducted earthquake disaster drill on every odd month & fire disaster on every even month. LPA's obtained a copy of Children's Roster. The Preschool Program is operating in only one classroom due to the pandemic. LPA toured the facility both indoor and outdoor. LPA's observed that the facility was operating in compliance with teacher to children ratio requirement. LPA observed two teachers teachers and a total of 21 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. LPA 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 was posted. Currently facility does not provide meals, nor snacks. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher & fire alarms and smoke detector were observed one in each classroom. At least one carbon Monoxide was observed as well.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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: EMPIRE MONTESSORI PRESCHOOL BILINGUAL-CHINESE	FACILITY NUMBER: 434412135
	VISIT DATE: 07/30/2021

NARRATIVE

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This facility is providing Incidental Medical Services – IMS Plan. However currently, there is no child enrolled required the services.

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. 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.

LPA's advised Director to review the California Department of Public Health date June 29, 2021, "GUIDANCE FOR CHILD CARE PROVIDERS AND PROGRAM". LPA advised Director that children above 2 years old shall be taught to wear face masks.

No deficiency was cited. LPA conducted an exit interview with Director.

A NOTICE OF SITE VISIT WAS ISSUED, AND TO BE POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC809 (FAS) - (06/04)

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