434413201-10-27-2022-07-CC-AMOS-CKLSXM-20221027141606

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413201
Report Date: 10/27/2022
Date Signed: 10/27/2022 04:25:31 PM

Document Has Been Signed on 10/27/2022 04:25 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:	CHILDREN'S WORLD BILINGUAL MONTESSORI		FACILITY NUMBER:	434413201
ADMINISTRATOR:	YU-CHIEH HSIUNG		FACILITY TYPE:	850
ADDRESS:	820 KIELY BLVD		TELEPHONE:	(408) 247-8600
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	60	CENSUS: 35	DATE:	10/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Michelle Hsiung		TIME COMPLETED:	02:05 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) Anna Morales conducted an unannounced Annual Required inspection. LPA met with Director, Michelle Hsiung at today's inspection. Facility's License, Notification of Parents’ Rights Poster, 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 8:30am--6:00pm. Age served is 2 years to entry into Pre-K. Last disaster drill was conducted in June 2022 The Preschool Program is operating in two classrooms. One is a toddler classroom and the other is a preschool classroom. LPA toured the facility both indoor and outdoor. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. LPA observed six teachers and a total of 35 children. There were no bodies of water observed. Director stated that the facility does 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 all in good condition. LPA observed resilient materials under the climbing structures. Drinking water was readily available to children indoor and outdoor. Activities schedule and Menu were posted. Facility does provide lunch (via a catering company) and two snacks (morning and afternoon). LPA observed that food storage areas were clean and free of litter.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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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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: CHILDREN'S WORLD BILINGUAL MONTESSORI	FACILITY NUMBER: 434413201
	VISIT DATE: 10/27/2022

NARRATIVE

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Fire extinguisher, smoke and carbon monoxide detectors were observed.

This facility is providing Incidental Medical Services – IMS Plan. Director stated there is an isolation area for sick children to wait for parent pick-up. Director also stated that there are children who are taking medications. LPA reviewed the Centrally Stored medications. LPA reminded Director to have the appropriate forms, such as a LIC9211(carrying out medical orders) and to have the staff's signature to verify that they have received training.
LPA was able to review a plan that was completed by the child's parents in event the medications needed to be given.

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 (TYY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/chidlqanda.htm

LPA 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 reviewed Staff's 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. LPA 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.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CHILDREN'S WORLD BILINGUAL MONTESSORI	FACILITY NUMBER: 434413201
	VISIT DATE: 10/27/2022

NARRATIVE

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LPA also 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 requirements of AB 633 and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Exit interview conducted and report was reviewed with the Director Michelle Hsiung. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC 809-D. Appeal Rights Given

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE CENTER FOR A PERIOD OF 30
DAYS.

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

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/27/2022 04:25 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CHILDREN'S WORLD BILINGUAL MONTESSORI	FACILITY NUMBER: 434413201
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(3)(A)

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation LPA observed that C9 EPI PEN expired on 1/2022, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/03/2022
	Plan of Correction
1 2 3 4	Director agreed to give back the expired EPI Pen to the C9's parent and obtain a non expired EPI PEN and will take photos of it and send to LPA as POC

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

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