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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415070
Report Date: 07/20/2021
Date Signed: 07/20/2021 11:10:45 AM

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 SCHOOLFACILITY NUMBER:
434415070
ADMINISTRATOR:AMANDA WAGNERFACILITY TYPE:
850
ADDRESS:1331 E. CALAVERAS BOULEVARDTELEPHONE:
(408) 263-6330
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:36CENSUS: 0DATE:
07/20/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Colleen NollTIME COMPLETED:
11:00 AM
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On Tuesday, July 20, 2021 10:00 am, Licensing Program Analyst (LPA) Manel Estoesta, Oakland South Regional Manager (RM) Anika Evans and Licensing Program Manager (LPM) Jason Jang conducted an announced Non-Compliance Conference (NCC) via Zoom Video Call. LPA, RM and LPM met with the Licensee Colleen Noll and the Director of Operations Yukha Lam-Khoo.

The purpose of today's NCC is to discuss the facility's compliance of the Title 22 regulations. This NCC is a result of a recent Type A citation issued on 06/10/2021 visit following an Incident reported on 06/04/2021. The licensee is in violation of California Code of Regulations Title 22, Division & Chapter 1 Article 06 Continuing Requirements 101229 Responsibility for Providing Care and Supervision (a)(1). Civil penalty was assessed.

The licensee assured that she understand the severity of the citation and has come into compliance with the regulation. A plan of correction clearance was provided on 06/16/2021. The licensee understands that no child(ren) shall be left without the supervision of a teacher at any time and supervision shall include visual observation.

The licensee understand that Community Care Licensing will increase monitoring of the facility for the next twelve months. The licensee was informed that any further noncompliance of serious violation will subject for administrative action.

RM, LPM and LPA discussed to the licensee the In-service Training, LIC 9224 completion and the Appeal Rights.

An exit interview was conducted with the licensee. A copy of this report will be mailed and emailed to the Director including a copy of the Appeal Rights today. The licensee or the director shall sign the report and send a copy to the LPA via email or mail. This report shall remain on file for 3 years.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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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