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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414755
Report Date: 08/28/2019
Date Signed: 08/28/2019 10:42:24 AM

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:EVERGREEN MONTESSORI SCHOOL - ARFACILITY NUMBER:
434414755
ADMINISTRATOR:PRAKASH, SUNITAFACILITY TYPE:
850
ADDRESS:3000 ABORN ROADTELEPHONE:
(408) 603-5000
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:50CENSUS: 26DATE:
08/28/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sneh AyareTIME COMPLETED:
10:50 AM
NARRATIVE
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On 08/28/19 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced POC Inspection at Evergreen Montessori - AR. LPA met with Director, Sneh Ayare and explained the purpose of today's inspection. There were 6 staff and 26 children present in the Center during today's inspection.
On 08/14/19 Center was cited for CCR 101229.1 Sign in/ sign out.
Today's POC inspection and review of files showed:
On 08/26/19 Child 1 of Cypress room (C-1) was not signed out by the authorized representative
On 08/27/19 Child 2 of Juniper room (C-2) was not signed out by the authorized representative.
Director stated at present their electronic sign in/out system is not working and is under repair. Parents for both rooms are manually signing their child on a common register kept in the lobby area. LPA spoke to teachers in each room, and they were unaware C-1 and C-2 were not signed out. Teachers do not have a visual view of the register kept in the lobby and they cannot immediately verify whether a parent signed in or out. Teachers mentioned they have been verbally reminding parents. During the inspection, Owner Sunita Prakash arrived and she separated the registers and kept it in the respective classrooms so that the teachers can ensure parents sign in/out.
A citation was issued on page 809-D. This is a repeat violation under CCR 101229.1 within 12 months. A civil penalty of $250 is assessed. Exit Interview was conducted, where this report, the citation, plan of correction, civil penalty and appeal rights was reviewed and discussed with Owner, Sunita Prakash.
A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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: EVERGREEN MONTESSORI SCHOOL - AR
FACILITY NUMBER: 434414755
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited

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101229.1 Sign In and Sign Out: Per LPA's review of files, On 08/26/19 C-1 (Cypress room) was not signed out. On 08/27/19 C-2 (Juniper room) was not signed. Teachers were not aware of this and parents were not informed to correct it.
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 The electronic system is not working and manual register for both rooms is placed in the Lobby. Teachers are unable to verify if a child was signed in or out. This poses a potential risk to the health and safety of children. This is a repeat violation within 12 months and a civil penalty of $250 is assessed.
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Teachers were instructed to ensure parents sign in/out. Director agreed to send a reminder email to all parents again. Citation was cleared during today's inspection

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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2019
LIC809 (FAS) - (06/04)
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