434415069-7-22-2022-52-CC-MESA-CGKRLR-20220722130735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415069
Report Date: 07/22/2022
Date Signed: 07/22/2022 01:07:45 PM

Document Has Been Signed on 07/22/2022 01:07 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
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) 945-1331
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	12	CENSUS: 10	DATE:	07/22/2022
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:49 AM
MET WITH:	Amanda Wagner and Melissa Wyant		TIME COMPLETED:	01:15 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 Friday, July 22, 2022 at 9am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year visit. LPA met with Child Care Center Director Amanda Wagner and Program Director Melissa Wyant. Present on this visit were 3 staff and 10 infant children. Facility operates from Monday to Friday 7am to 6pm. LPA toured the facility to conduct a Health and Safety Inspection with the Program Director. The Infant Program is in the Nido Room. The Facility has two active waivers in file (shared bathroom with preschool program with license #434415070 and electronic sign in/out) and facility follows the conditions of both waivers on today's visit. LPA observed the required posted materials and facility in compliance. The child care center is clean, safe and sanitary. Facility bathrooms are clean, sanitary and operable. There is a separate staff bathroom not utilized by the children which also an Isolation Bathroom for a Sick Child. Bed boxes previously reviewed and approved by the department are used instead of cribs. Mats are used for older children. LPA observed 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. Program Director stated that facility does not possess nor store any weapons on the premise. LPA observed 10 infants with 3 attending staff (teacher and aide). The teacher/child ratio was in compliance during today's visit. Director understands the conditions, limitations, and capacity. Director understands that infants shall always be visually supervised 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: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

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: 07/22/2022

NARRATIVE

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Continuation.

LPA reviewed Disaster Drill as the following;

1. Fire Drill are done monthly and last drill conducted 06/14/2022
2. Earthquake Drill were done in 03/09/2022 and 06/30/2022.

Facility files were reviewed. Child sign in and out procedures, logs were reviewed via the facility's online platform "One Core" and LPA obtained a copy. LPA also obtained copies of the Facility's updated Personnel Report and Child Care Facility Roster.

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.

LPA reviewed 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 (Infant Feeding and Toilet Training), LIC 9227 individual feeding plan and LIC 9224 Acknowledgement of Receipt of Licensing Reports. LPA reviewed Sleep Logs via facility's online platform with the Program Director.

LPA discussed the PIN 21-21-CCP, PIN 20-24-CCP and PIN 22-10-CCP to the Program Director.

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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

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: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 07/22/2022

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Continuation.

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/inspection-process.

Directors were reminded 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 discussed the safe sleep regulations with Directors and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Program Director Melissa Wyant and Child Care Center Director Amanda Wagner.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022

LIC809 (FAS) - (06/04)

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