434415069-7-21-2021-52-CC-MESA-C55SYL-20210721141744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415069
Report Date: 07/21/2021
Date Signed: 07/21/2021 02:20:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CALAVERAS MONTESSORI SCHOOL		FACILITY NUMBER:	434415069
ADMINISTRATOR:	AMANDA WAGNER		FACILITY TYPE:	830
ADDRESS:	1331 E. CALAVERAS BOULEVARD		TELEPHONE:	(408) 263-6330
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	12	CENSUS: 5	DATE:	07/21/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Amanda Wagner		TIME COMPLETED:	02:30 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	Wednesday, July 21, 2021 at 9:56 AM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year visit. LPA met with Director (D1) Amanda Wagner and Director of Operations (D2) Yukha Lam-Khoo. Present on this visit were 2 staff and 5 infant children. The Facility has two active waivers in file (shared bathroom with preschool program and electronic sign in/out) and is in compliance with the conditions of both waivers on today's visit. Facility operates from Monday to Friday 7am to 6pm. LPA toured the facility to conduct a Health and Safety Inspection with D2. Facility is using the Nido Room.The Facility also has a preschool program (#434415070) in (Pre-primary room) and (primary room). LPA observed the required posted materials. D2 stated that facility does not possess nor store any weapons on the premise. Bed boxes, previously reviewed and approved by the department are used instead of cribs. Mats are used for older children. Bottles, dishes, and containers of food brought by the infant’s authorized representative are labeled with the infant’s name and the current date. The infant changing tables are placed within arm’s reach of a sink while in use. Outdoor activity space is fenced and play equipment were maintained in a safe condition and free of hazards. The areas around or under play structures are cushioned with poured rubber foam. LPA observed solid waste containers with tight-fitting lids in each room and in the playground. The child care center is clean, safe, sanitary, and free of flies, other insects, and rodents. The child care center is in good condition and is safe for children, staff and visitors. LPA observed 5 infants with 2 attending staff (teacher and aide). The teacher/child ratio was in compliance during today's visit. Director understands the conditions, limitations, and capacity specifications of the facility license. Director understands that infants shall be visually supervised at all times and never left unattended. See 809 C.....

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CALAVERAS MONTESSORI SCHOOL	FACILITY NUMBER: 434415069
	VISIT DATE: 07/21/2021

NARRATIVE

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LPA reviewed Disaster Drill as the following;
1. Fire Drill are done monthly and last date since 06/30/2021.
2. Earthquake Drill were done in 02/23/2021 and 05/25/2021.

Milpitas Fire Annual Inspection was last conducted in 2019. D2 stated that she will call the Fire Department to follow up the annual inspection. LPA observed Smoke alarm, carbon monoxide and Fire Extinguisher was last serviced in April 2021.

Director understands that personnel records on the licensee, administrator, and each employee shall be maintained. LPA reviewed four staff files. All staff files reviewed contains the required transcripts/verification of experience. The infant teacher is fully qualified. LPA observed at least one teacher has current CPR and First Aid certifications on file. 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).

Director understands that a separate, complete, and current record for each child shall be maintained. LPA reviewed eight children files. LPA observed the medical assessment and the Information and Emergency Information form (LIC 700) in the children files. Each child’s file contains a Needs and Services Plan which includes an individual feeding plan.

Facility files were reviewed. Child sign in and out procedures, logs were reviewed and LPA obtained a copy. Children files were reviewed, which included records of Admission Agreement, Identification and Emergency Information, Medical Assessment, Immunization, LIC 9227 and or Infant/toddler Needs and Plan, the signed LIC 9224 Acknowledgement of Receipt of Licensing Reports (LIC 9224) for the 06/10/2021 visit and will complete the LIC 9224 for the 07/21/2021 Non-Compliance Conference.

Staff files were reviewed, which included records of Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, records of immunization, and required Training. Teachers have the required education credits and experience. There was at least one person with documented training on preventive health practices, including current certification in Pediatric CPR and First Aid present at the facility.
See 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CALAVERAS MONTESSORI SCHOOL	FACILITY NUMBER: 434415069
	VISIT DATE: 07/21/2021

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Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at:
http://www.mandatedreporterca.com/

LPA discussed and copies provided the following;

1. PIN 20-01 REQUIRED LEAD TESTING FOR DRINKING WATER IN LICENSED CHILD CARE CENTERS AND THE PROVISION OF LEAD EXPOSURE INFORMATION TO PARENTS AND GUARDIANS BY ALL LICENSED CHILD CARE FACILITIES
2. LEAD PUB 515.
3. Santa Clara Resource and Referral
4. Child Care Stipends

In the areas that were evaluated, no deficiencies were observed at the time of the visit. Exit Interview was conducted with Director.

A NOTICE OF SITE VISIT WAS ISSUE 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: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

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