434414163-1-12-2023-07-CC-YHUG-CMZUBU-20230112142654

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414163
Report Date: 01/12/2023
Date Signed: 01/12/2023 02:27:02 PM

Document Has Been Signed on 01/12/2023 02:27 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:	LITTLE TREE BILINGUAL MONTESSORI		FACILITY NUMBER:	434414163
ADMINISTRATOR:	Y FEN SHIH		FACILITY TYPE:	850
ADDRESS:	20111 STEVENS CREEK BLVD.#150&		TELEPHONE:	(408) 996-3399
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	125	CENSUS: 80	DATE:	01/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Y Fen (Amanda) Shih		TIME COMPLETED:	02:40 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	Page 1 Licensing Program Analyst (LPA), Oscar, conducted an unannounced annual inspection of the Preschool. LPA met with Director, Y Fen (Amanda) Shih and informed her of the purpose of the visit. LPA observed Notification of Parents’ Right Poster, Children's Personal Rights, Child Car Seat Laws, Child Care License, LIC 610 Emergency Disaster Form (1 and 2), Personnel Report, Meal Menu, Activity schedule, and LIC308 Designation of Responsibilities observed to be posted. Facility’s operating days and hours are Monday- Friday 09:00 AM to 06:00 PM. During visit, LPA observed a ratio of 80 to 15 staff. All staff present on site are associated to the facility. LPA reminded director 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 inspected the building inside and out with Director Amanda Shih. The Preschool classroom (s), restroom (s) for children to use and office area, storage area, food storage areas were inspected. Furniture and equipment were observed to be age appropriate and free of sharp, loose, or pointed parts. There is a separate staff rest-room in the campus the building and in the office.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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: LITTLE TREE BILINGUAL MONTESSORI	FACILITY NUMBER: 434414163
	VISIT DATE: 01/12/2023

NARRATIVE

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Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides snacks & meal, and are prepared from licensed restaurant. LPA observed that food storage areas. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on.

The preschool playground is completely enclosed by fencing. Activity schedule was posted. LPA observed play equipment were maintained, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Director stated that facility does not have weapons on the premises. Drinking water is arranged to be readily available to children via purified machine. Shade is provided by canopies, building overhang, etc. First Aid kit was inspected. Fully charged fire extinguisher, smoke and carbon monoxide detectors were observed.

LPA observed proof of recorded of the last fire/disaster drill which is conducted monthly. LPA reviewed facility's sign in/out procedure and record which is in compliance with regulation.

A sampling of children and staff files was selected for review. Children records reviewed includes: Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization.

Staff records reviewed include: Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. Almost all the staff with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' inspection.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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: LITTLE TREE BILINGUAL MONTESSORI	FACILITY NUMBER: 434414163
	VISIT DATE: 01/12/2023

NARRATIVE

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This facility provides Incidental Medical Services – 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. LPA observed the facility plan of operation for providing IMS is on file. LPA observed IMS serviced child file that is in compliance with regulation.

Director is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations etc.

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/process.

No deficiency was cited. A notice of site visit was given and must remain posted for 30 days. The report was discussed during the exit interview with Director, Y Fen (Amanda) Shih.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng Huang	TELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC809 (FAS) - (06/04)

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