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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413036
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:00:21 PM


Document Has Been Signed on 11/16/2022 02:00 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:GLOBAL VILLAGE MONTESSORIFACILITY NUMBER:
434413036
ADMINISTRATOR:SELVASUMATHI NAMOKAREANFACILITY TYPE:
850
ADDRESS:1146 JACKLIN ROADTELEPHONE:
(408) 956-8711
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:72CENSUS: 41DATE:
11/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Nikki YelamTIME COMPLETED:
02:00 PM
NARRATIVE
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On Wednesday, November 16, 2022 at 8:40 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an Unannounced Required 1 Year Visit. LPA met with Nikki Yelam (President and Licensee) and explained the nature of the site visit. Present on this visit were 7 Staff and 41 Preschool Children. The facility operates from Monday to Friday, 8 am to 5:30 pm.

LPA toured the facility to conduct a Health and Safety Inspection with Nikki. The Facility has three active licensed rooms which are the Penguin Room, Dolphin Room and Turtle Room. The facility has an outdoor activity space and for electronic sign in/out waiver which was observed to be posted together with the Facility’s License, Parents’ Rights Poster, Personal Rights, AM PM Snack Menu and Activity Schedules. Facility was observed to follow teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers.

The classrooms, restrooms, pantry, storage room, and office area were inspected. Nikki stated that facility does not possess nor store any weapons on the premises. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Cabinets, drawers, and rooms used for storage were locked. 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.
Outdoor activity space is fenced and was inspected. The play equipment was 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. There were shaded rest areas for children. Drinking water are arranged to be readily available to children during indoor and outdoor activities.

See 809 C.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022
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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Document Has Been Signed on 11/16/2022 02:00 PM - It Cannot Be Edited

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: GLOBAL VILLAGE MONTESSORI
FACILITY NUMBER: 434413036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's Record Review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Staff 4 was hired a new Director in March 2022 and there were no reporting submitted to the Regional Office.
POC Due Date: 11/30/2022
Plan of Correction
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Staff 4 is no longer working at the facility and Nikki hired Staff 5 as a New Director. Nikki will submit Exception Request and New Director Documentation for LPA's Evaluation by the end of November 2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022
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: GLOBAL VILLAGE MONTESSORI
FACILITY NUMBER: 434413036
VISIT DATE: 11/16/2022
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Continuation.
Food and beverages were kept protected against contamination and spoilage. Children's lunches and water bottles are brought from home. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair.

Facility files were reviewed. Children sign in and out procedures and logs were reviewed. Facility is currently using an electronic sign in and out system called "Sign In App" application and LPA reviewed the system's operation/logging with Nikki. LPA observed daily attendance completion in each room. Children's Medication are in the classroom.

A sampling of Children's files was taken for review. The records reviewed include Admission Agreement, Identification and Emergency Information, Medical Assessment, and Immunization.

A sampling of Staff's files was taken for review. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. LPA reminded Nikki that AB 1207 Child Care Providers training online at https://mandatedreporterca.com/ requires 2-year requirement. LPA reviewed Staff Immunization records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Facility Representative that only the Influenza vaccination can be decline with a written declination.

LPA obtained copies of the Children's and Staff Sign in and Out, LIC 500 and Facility's Children's Roster.

Director stated that facility does handle medications and does currently have children in care who requires Incidental Medical Services - IMS Epinephrine and Inhaled Medication. LPA reviewed storage of medication and equipment/supplies, 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.
See 809 C.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC809 (FAS) - (06/04)
Page: 11 of 12
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: GLOBAL VILLAGE MONTESSORI
FACILITY NUMBER: 434413036
VISIT DATE: 11/16/2022
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Continuation.

LPA observed Smoke and Carbon Monoxide Detectors, fire pull stations, fire extinguishers and sprinkler system. At 10 am, Milpitas Fire Department conducted a Fire and Disaster Drill at the facility. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in park vehicles.

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.

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/inspection-process.

LPA discussed the LIC 311 A, PIN 21-21-CCP Release of the Written Directives for Lead Testing, Documentation Required for New Director and American Rescue Plan Act Survey.

This report includes Technical Violation and LIC 809 D with a Type B Citation.

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, Nikki Yelam.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC809 (FAS) - (06/04)
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