434412725-8-26-2021-52-CC-MESA-C69NW9-20210826104911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412725
Report Date: 08/26/2021
Date Signed: 08/26/2021 10:49:19 AM

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:	MAIN STREET MONTESSORI SCHOOL		FACILITY NUMBER:	434412725
ADMINISTRATOR:	MARISSA PARKER		FACILITY TYPE:	850
ADDRESS:	630 SOUTH MAIN STREET		TELEPHONE:	(408) 772-6661
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	72	CENSUS: 38	DATE:	08/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	KRYSTAL GALLARDO		TIME COMPLETED:	11:00 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	On Thursday, August 26, 2021 at 8:30 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year visit. LPA met with the Director Krystall Gallardo and explained the nature of site visit. Present on this visit were 8 staff and 38 preschool children. Facility operates from Monday to Friday 7am to 6pm. LPA toured the facility to conduct a Health and Safety inspection. Facility’s License, Parents’ Rights Poster, Personal Rights, Menus, Activity Schedules and Waivers were observed to be posted. Facility was observed to be in compliance with teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers. Facility has two (2) classrooms with the following naming convention: Maple Room and Sycamore Room. The two (2) preschool classrooms, preschool restrooms, storage, and office / staff room and staff restrooms were inspected. Director stated that facility does not possess nor store any weapons on the premise. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Furniture and equipment such as mats, cots, tables, and chairs were age appropriate and were in good condition, free of sharp, loose, or pointed parts. Restrooms for children's use were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. The facility provides morning and afternoon snacks for the children. Children either bring their lunch from home or can order lunch online and have it delivered through School Caterers. Snacks are prepared in a separate small kitchen. Foods and beverages were kept protected against contamination and spoilage. Menus were posted. Kitchen and food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans use for solid waste had tight-fitting covers on, and were in good repair. 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: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: MAIN STREET MONTESSORI SCHOOL	FACILITY NUMBER: 434412725
	VISIT DATE: 08/26/2021

NARRATIVE

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Outdoor activity space is fenced and play equipment were maintained in a safe condition and free of hazards. There were no bodies of water observed. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. Drinking water are arranged to be readily available to children during indoor and outdoor activities.

Director stated that facility does handle medications and is providing Incidental Medical Services – IMS: Epinephrine and Inhaled Medication. LPA reviewed storage of medication and equipment/supplies and Facility's current IMS Plan for Epinephrine, and reviewed children’s, personnel, and administrative records. 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.

Facility files were reviewed. Children sign in and out procedures and logs were reviewed. A random sampling of Children's files were selected for review. The records reviewed include Admission Agreement, Identification and Emergency Information, Medical Assessment, and Immunization.

There was at least one person with current certification in Pediatric CPR and First Aid present at the facility during inspection. A random sampling of Staff's files were selected for review. The records reviewed include: Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Education Qualification, records of immunization (Measles and Pertussis), and required Training such as the AB1207 Mandated Reporter Training.

LPA obtained copies of the LIC 9040, LIC 500 and Sign In and Out sheets.

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: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: MAIN STREET MONTESSORI SCHOOL	FACILITY NUMBER: 434412725
	VISIT DATE: 08/26/2021

NARRATIVE

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Licensee [or 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 safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA discussed, provided copies of PIN 21-21-CCP RELEASE OF THE WRITTEN DIRECTIVES FOR LEAD TESTING OF
WATER IN LICENSED CHILD CARE CENTERS PER AB 2370 and Lead Poisoning Facts Flyerto the director. For more information, please follow the linkhttps://cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Krytal Gallardo.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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