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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414163
Report Date: 02/14/2024
Date Signed: 02/14/2024 04:11:11 PM


Document Has Been Signed on 02/14/2024 04:11 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 MONTESSORIFACILITY NUMBER:
434414163
ADMINISTRATOR:Y FEN SHIHFACILITY TYPE:
850
ADDRESS:20111 STEVENS CREEK BLVD.#150&TELEPHONE:
(408) 996-3399
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:125CENSUS: 53DATE:
02/14/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Y Fen (Amanda) ShihTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA), Oscar Huang, conducted an unannounced annual inspection of the Preschool. LPA met with Director, Y Fen (Amanda) Shih and informed her the purpose of the visit.
LPA arrived at the facility at 1:00 pm, and 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), LIC308 Designation of Responsibilities, and menu observed to be posted. Facility’s operating days and hours are Monday- Friday 08:15 AM to 06:00 PM. During visit, LPA observed a ratio of 53 to 11 staff. All staff present on site are associated to the facility.
Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
LPA inspected the building inside and out with Director, Y Fen Shih. The Preschool indoor classrooms/restrooms for children to use and office area, storage area, and kitchen 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 next to the kitchen/staff room area.
Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides am/pm snacks and options for lunch which meals are prepared and provided from licensed restaurant outside. 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.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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: 02/14/2024
NARRATIVE
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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. Facility representative stated that facility does not have weapons on the premises. Drinking water is arranged to be readily available to children filed by teachers with children's own bottles. Shade is provided by trees, 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. LPA reviewed facility's sign in/out procedure and record.

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. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' inspection.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/

LPA reviewed with facility director the violations that would result in an immediate $500 civil penalty assessment. 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.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
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: 02/14/2024
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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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

LPA verified that the lead testing was completed on November 8, 2022 with passed results as well as all the required documents submitted and on files in accordance to the Written Directives outlined in PIN 21-21.1.CCP.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiency was sited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Y Fen (Amanda) Shih.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
LIC809 (FAS) - (06/04)
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