434412157-5-23-2019-07-CC-MMOO-BCFRGD-20190523130034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412157
Report Date: 05/23/2019
Date Signed: 05/23/2019 01:00:42 PM

COMPREHENSIVE INSPECTION

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:	APPLETREE MONTESSORI SCHOOL		FACILITY NUMBER:	434412157
ADMINISTRATOR:	RENU JAYA		FACILITY TYPE:	850
ADDRESS:	653 WEST FREMONT AVENUE		TELEPHONE:	(650) 575-9147
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	40	CENSUS: 35	DATE:	05/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:33 AM
MET WITH:	Renu Jaya		TIME COMPLETED:	01:10 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 Analyst (LPA), Marilou Monico, conducted an annual random inspection. LPA met with Site Director, Renu Jaya, and explained the nature of today's visit. The facility utilizes two classrooms for the preschool program: Rooms 1 and 2. LPA reviewed sign in/sign out sheets and children's roster. Copy of children's roster was obtained. LPA observed all required posted materials: License, Parent’s Rights, Emergency Disaster Plan, menus, Earthquake Preparedness Checklist, Child Passenger Safety Law, and activity schedule. The facility was toured inside and outside. The facility observed to be clean, safe, and in good repair. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible to children. Furniture and equipment were age-appropriate and in good condition. Restrooms for children’s use were observed to be sanitary and operable. Trash cans used for the disposal of solid waste have tight fitting lids. Site Director states that there are no weapons on the premise. LPA observed functioning carbon monoxide detector, and smoke detectors. LPA did not observe any bodies of water. LPA reviewed six random children's files and five staff files. Two teacher's passports were completed. The facility provides morning and afternoon snacks to the children in care. There is a kitchen at the building for food preparation. The kitchen was observed to be clean and sanitary. The kitchen is equipped with microwaves, stoves, ovens, refrigerator, and a sink with hot and cold running water. LPA observed adequate food for snacks. There is a climbing structure on the playground with tanbarks as resilient material. Shade is provided by trees and outdoor patio. Drinking water outdoor is provided through drinking fountains. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 05/29/19):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019

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: APPLETREE MONTESSORI SCHOOL	FACILITY NUMBER: 434412157
	VISIT DATE: 05/23/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 05/23/19)

Staff present during the inspection have cleared criminal record and child abuse index clearances or exemptions. LPA also reminded Site 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. Penalty amounts: minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. AB 633 was discussed with Site Director. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. LPA discussed and provided Site Director a copy of lead information sheets and advised her to provide copies to parents.

Site Director stated that she currently has no children in care who requires Incidental Medical Services (IMS) services. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

As a result of this inspection, deficiencies were cited on the following page:

A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: APPLETREE MONTESSORI SCHOOL	FACILITY NUMBER: 434412157
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/23/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/24/2019 Section Cited HSC 1596.8662(b)(1)	1 2 3 4 5 6 7	MANDATED REPORTER TRAINING - On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.	1 2 3 4 5 6 7	Site Director states she will submit proof of completion for her and staff #1 thru #4 by 06/24/2019.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: LPA observed that Site Director and Staff #1 thru #5 have not completed the Mandated Reporter Training that began on January 1, 2018. This poses a potential risk to Health, Safety to children in care.	8 9 10 11 12 13 14
Type B 06/24/2019 Section Cited HSC 1596.7995(a)(1)	1 2 3 4 5 6 7	SENATE BILL 792 - Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.	1 2 3 4 5 6 7	Site Director states she will submit proof of immunizations for staff #1, #2, #3, and #5 by 06/24/19.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Staff #1 & #2 are missing immunization in measles. Staff #3 and #5 are missing immunization in measles, pertussis, and influenza. This poses a potential risk to the health and safety to children in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019

LIC809 (FAS) - (06/04)

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