434413685-4-14-2022-07-CC-PHEZ-CDGTC7-20220414143616

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413685
Report Date: 04/14/2022
Date Signed: 04/14/2022 02:36:32 PM

Document Has Been Signed on 04/14/2022 02:36 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:	APPLESEED MONTESSORI SCHOOL		FACILITY NUMBER:	434413685
ADMINISTRATOR:	MARCIA TAI		FACILITY TYPE:	850
ADDRESS:	972 SOUTH DE ANZA BLVD		TELEPHONE:	(408) 470-4701
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	171	CENSUS: 103	DATE:	04/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Marcia Tai		TIME COMPLETED:	03:05 PM

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Licensing Program Analyst (LPA) Pete Hernandez conducted an unannounced, Required 1 Year, inspection on today’s date. LPA met with Site Director, Marcia Tai. Macia had to leave at 10:30 and the inspection was completed with the help of Assistant Director Jennifer Nugent. There were 15 qualified teachers, 97 Preschoolers and 6 Toddler Component children in care at the time of inspection. There were 13 preschoolers in Room 1 with two Teachers, and 18 preschoolers in Room 2 with three Teachers. There were 13 Preschoolers in Room 3 with 2 Teachers. There were 14 preschoolers in Room 4 with two Teachers, There were 6 Toddlers in the Blue Room with Two Teachers. There were 17 Preschoolers in the Green Room with 3 Teachers and there were 7 Preschoolers in the Yellow Room with one Teacher. (Please note that the census changed from morning to the afternoon at completion of the inspection.) Facility’s License, Parents’ Rights Poster PUB393, Personal Rights, Activity Schedules, and Menus were observed to be posted. Teachers. Normal business hours are Monday through Friday 8:30am through 5:00pm.

There is one waiver on file: Out door space. This hanging with all the postings.

LPA completed a physical plant inspection touring Front Building and the Rear Building, and outside play areas, and the main entrance/office. A review of staff records during today's inspection indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Site Director understands that all adults that work with the children must have a clearance associated to the facility before they can be present. Failure to do so will result in an immediate penalty. LPA discussed the zero tolerance related regulations.

Page 1 is continured on Page 2 for inspection conducted on 04/14/2022.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: APPLESEED MONTESSORI SCHOOL	FACILITY NUMBER: 434413685
	VISIT DATE: 04/14/2022

NARRATIVE

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There are no bodies of water. Director states there are no weapons at the center. Furniture and equipment is age appropriate and in good condition free of sharp, loose or pointed parts. Restrooms and changing stations for the children were observed and noted to be clean and in good repair. Floors appear clean and safe. Trash cans for food waste and soiled diaper have tight-fitting covers. No flies, insects or rodents were observed during the inspection. Playground is maintained in a safe condition and free of hazards.

Children were supervised during the inspection. Thirteen of the children's files were reviewed and contained an admission agreement and required documentation. All rooms had sufficient napping equipment. Temperature was noted at 68 degrees in all rooms and was comfortable for the children in care.

Staff files have copies of transcripts and teachers have the appropriate education credits. Observed CPR & First Aid for at least one staff person present. Site Director's first-aid expires 9/2023. Emergency Drills are performed on a monthly basis and the last one was logged on 2/9/2022.

Facility has age appropriate furniture and equipment, including cribs on Infant side, mats, feeding chairs, and changing tables. No baby walkers or bouncers were witnessed during the inspection. All storage containers for solid waste had tight fitting covers and were in good repair. Facility was free of flies, other insects, and rodents. Facility has adequate indoor activity space for children that is physically separate from space used by the preschool child care center. Bottles, dishes, and containers of food brought by the child's authorized representative are labeled with the child's name and current date. Facility has posted monthly menus and back up food for the children. Facility has at least one functioning carbon monoxide detector and smoke alarms with Fire pull stations that meets statutory requirements. Facility has adequate outdoor activity space and play equipment that is maintained in a safe condition and is free of hazards. Facility maintains a kitchen for the children.

The outdoor activity area is surrounded by appropriate fencing. The play structure and equipment outside were age appropriate in good condition. Areas around play structure were cushioned with resilient materials. LPA did not observe any bodies of water.
Continued on Page #3 of Report dated 04/14/2022

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

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

FACILITY NAME: APPLESEED MONTESSORI SCHOOL	FACILITY NUMBER: 434413685
	VISIT DATE: 04/14/2022

NARRATIVE

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All Staff were fingerprinted and associated to the facility. LPA reminded 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. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. Children's Roster, sign in and sign out sheets, were reviewed, and a copies obtained. Director's CPR / First Aid card expires 9/2023.

LPA Hernandez reviewed the files of 15 Staff and 12 children. All or the required documentation was available in the file. With the exception of 9 staff has expired Mandated Reporter Certificates or were missing from the file. These Staff are identified as S1, S2, S3, S4. S5, S6, S7, and S8 on the confidential names list.

LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed. 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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

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

FACILITY NAME: APPLESEED MONTESSORI SCHOOL	FACILITY NUMBER: 434413685
	VISIT DATE: 04/14/2022

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TYPE A language: SHOULD THERE EVER BE AN ISSUANCE of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with the Licensee. A copy of this report, plan of corrections and appeals rights were discussed and left with the Licensee, Marcia Tai, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/14/2022 02:36 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: APPLESEED MONTESSORI SCHOOL	FACILITY NUMBER: 434413685
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA Pete hernandez's [(observation) (interview) (record review)], the licensee did not comply with the section cited above: Staff indentified as S1, S2, S3, S4, S5, S6, S7, and S8 did not have current Mandated Reporter Certificates on file. This poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/14/2022
	Plan of Correction
1 2 3 4	BY POC DUE DATE: Staff indentified as S1, S2, S3, S4, S5, S6, S7, and S8 will complete the training and send a copy of the Certificates of Completion to Licensing Office.

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: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC809 (FAS) - (06/04)

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