434414879-2-29-2024-07-CC-FRAA-D2WNXR-20240229095134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414879
Report Date: 02/28/2024
Date Signed: 02/29/2024 09:51:54 AM

Document Has Been Signed on 02/29/2024 09:51 AM - 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:	CABRILLO MONTESSORI SCHOOL INC		FACILITY NUMBER:	434414879
ADMINISTRATOR:	CINDY PHUNG		FACILITY TYPE:	850
ADDRESS:	2495 CABRILLO AVENUE		TELEPHONE:	(408) 263-6330
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	89	CENSUS: 69	DATE:	02/28/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Cindy Phung and Annie Encina		TIME COMPLETED:	12:30 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	On 02/28/2024 at 9:10am, Licensing Program Analyst (LPA), Farida Raja, met with Director, Cindy Phung and Operations Manager, Annie Encina, for an unannounced Required-3 Year inspection and informed Director of the purpose of today’s inspection. The facility is licensed to serve children ages 2 years to entry into first grade in four rooms. The facility has one waiver on file for electronic sign in/ out. LPA observed the required posted materials in the facility lobby including monthly menus. Days and hours of operation are Monday through Friday, 7:00 am to 6:00 pm. LPA toured the indoor and outdoor areas of the facility with Director and Operations Manager and observed the following ratios in each classroom: Pinnacles Room- 12 children: 3 teachers Sequoia Room- 22 children ; 2 teachers Denali Room- used for extracurricular activities and to provide afternoon care. Yellowstone Room- 33 children : 3 teachers Facility was in compliance with teacher to children ratio requirement. There is a working telephone at the facility (408-418-3568). Classrooms, children's restrooms, staff restrooms, kitchen, lobby, outdoor including garden area were inspected. During today's inspection, LPA observed children having breakfast and engaged in individual and group activities under the visual supervision of teachers. Facility has central heating/cooling for comfort of children. Director states that there are no weapons or firearms on the premises. Disinfectants and cleaning products were stored in high cabinets inaccessible to the children in care. Cabinets used for storage were observed to be child locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Napping mats were appropriate. LPA observed solid waste containers with tight-fitting lids in the rooms. Continued on Page 2

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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: CABRILLO MONTESSORI SCHOOL INC	FACILITY NUMBER: 434414879
	VISIT DATE: 02/28/2024

NARRATIVE

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Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. LPA observed a trash can with tight fitting cover for the disposal of diapers. Staff has separate bathrooms that can be utilized by sick children if needed.

LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. The facility has a built-in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 2/1/2024 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children in each room via water dispensers and disposable cups. The water dispensers are refilled using filtered water pitchers. Facility provides drinking water outdoors using water pitchers and disposable cups. Facility is not subject to the Lead Testing requirement as it was constructed after January 1, 2010. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility provides AM and PM snack and children bring lunch from home. Snacks are stored in the kitchen area and storage areas were observed to be clean. Snack preparation areas in each classroom were observed to be clean. Monthly menu was observed to be posted in each classroom along with a list of children with food allergies or preferences.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. Play equipment was in good condition, age-appropriate and has rubber flooring under high climbing structures as resilient material to absorb falls. Shaded rest area is provided by trees. There were no bodies of water observed. LPA discussed with Director about plans for obtaining more tan bark and having staff even out tan bark before children go outside.

Children sign in and out procedures and logs were reviewed. Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed seven (7) random children's files during today's inspection. Each child's file reviewed contained the required forms.

A random sample of three (3) staff records were reviewed and all teachers and staff maintain valid background clearances. All staff files reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current CPR and First Aid certification.

Continued on Page 3

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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: CABRILLO MONTESSORI SCHOOL INC	FACILITY NUMBER: 434414879
	VISIT DATE: 02/28/2024

NARRATIVE

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Director 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). All staff have the required immunization's against pertussis, measles and influenza/statement declining the vaccine. LPA also observed the required Mandated Reporter Training on file for all staff.

Director and Operations Manager were 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Medication was observed to be stored in backpacks in each classroom, out of reach of children. Isolation of sick child was discussed, and Director explained that sick children will be isolated in the director's office and isolation equipment will be provided. Staff restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility. 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-care-centers/.

Facility does not provide transportation to children, but Director understands that children cannot be left in parked vehicles unattended at any time, the vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system. Director stated that parents volunteer to provide transportation during field trips.

Director and Operations Manager 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.

Continued on Page 4

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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: CABRILLO MONTESSORI SCHOOL INC	FACILITY NUMBER: 434414879
	VISIT DATE: 02/28/2024

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

Exit interview conducted and report was reviewed with Director, Cindy Phung and Operations Manager, Annie Encina.

As a result of today's inspection, there were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC809 (FAS) - (06/04)

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