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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413313
Report Date: 03/08/2022
Date Signed: 03/08/2022 03:30:17 PM


Document Has Been Signed on 03/08/2022 03:30 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:WAHA MONTESSORIFACILITY NUMBER:
434413313
ADMINISTRATOR:WAHA MONTESSORIFACILITY TYPE:
850
ADDRESS:1101 STRAYER DRIVETELEPHONE:
(408) 366-2955
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY:94CENSUS: 10DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Lili LiTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Oscar Huang met with licensee, Lili Li for an unannounced annual inspection. LPA explained the nature of today’s inspection to Licensee. LPA also observed 2 staff and 10 preschool day care children in the facility during today's inspection. Days and hours of operation are Monday to Friday, 9:00am to 6:00pm.

Licensee, Lili Li was reminded that all adults 18 and over living or working in the facility, 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 licensed Family Child Care Home. 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.

Incidental Medical Services (IMS) policy was discussed. Licensee, Lili Li stated that the facility has a IMS plan, but currently there is no children required IMS services. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

No deficiency was cited. Exit interview conducted and report was reviewed with licensee, Lili Li. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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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