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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413905
Report Date: 06/17/2019
Date Signed: 06/17/2019 01:52:58 PM

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:MANTRA MONTESSORIFACILITY NUMBER:
434413905
ADMINISTRATOR:STEPHANIE WHITAKERFACILITY TYPE:
850
ADDRESS:853 GARY AVETELEPHONE:
(408) 730-2222
CITY:SUNNYALESTATE: CAZIP CODE:
94086
CAPACITY:35CENSUS: 18DATE:
06/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Stephanie WhitakerTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Mel Matos, met with Stephanie Whitaker, director, for an unannounced annual/random inspection. LPA toured the Facility both inside and outside during today's inspection. LPA notes that the Facility is licensed in Rooms A, B, C, & D and Playgrounds A, B, & C. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule.

A review of staff records on June 17, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Stephanie 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

LPA reviewed ten children and five (1 director and 3 teachers) staff files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All five staff files (1 director & 4 teachers) reviewed contain the required transcripts/verification of experience. All staff have current CPR and First Aid certifications & proof of completion of the Mandated Reporter Training for child care workers on file. Stephanie understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips).

LPA observed that the teacher/child ratio was in compliance during today's inspection. Stephanie understands the conditions, limitations, and capacity specifications of the Facility license. Stephanie understands that children shall be visually supervised at all times. LPA observed 1 teacher with napping children in Room A and 1 teacher with 7 children in Room B during today's inspection.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/17/2019):
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: MANTRA MONTESSORI
FACILITY NUMBER: 434413905
VISIT DATE: 06/17/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/17/2019):

LPA observed that all rooms are clean and safe for all children and staff. Stephanie states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Drinking water is readily available for the children in each room and in the outdoor playground area via water coolers/disposable cups. LPA observed solid waste containers with tight-fitting lids in the Facility. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Stephanie states that there are no weapons or firearms on the premises.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground areas (A, B, & C) utilized by children are surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition.. There is sufficient resilient materials in the playground area. LPA did not observe any bodies of water.

LPA conducted an exit interview with Stephanie prior to the conclusion of today's inspection and Stephanie agreed to submit an updated Emergency Disaster Plan (LIC 610) to LPA Matos by Friday June 21, 2019.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2019
LIC809 (FAS) - (06/04)
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