434415095-11-1-2024-07-CC-JBER-DALSEM-20241101134858

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415095
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:49:19 PM

Document Has Been Signed on 11/01/2024 01:49 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ONE WORLD MONTESSORI SCHOOL, INC. LEIGH		FACILITY NUMBER:	434415095
ADMINISTRATOR/ DIRECTOR:	KAREN BAMBERG		FACILITY TYPE:	850
ADDRESS:	4343 LEIGH AVENUE		TELEPHONE:	(408) 615-1254
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY: 67	TOTAL ENROLLED CHILDREN: 67	CENSUS: 30	DATE:	11/01/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:49 AM
MET WITH:	Kristi Burdsall, Office Manager		TIME VISIT/ INSPECTION COMPLETED:	01:55 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	Licensing Program Analyst (LPA), Jennifer “Jen” Beehler, met with Kristi Burdsall, Interim Office Manager for an unannounced Required- 3 Year Inspection. LPA was granted access to the facility by the Facility Representative and toured both indoors and outdoors during the inspection. Upon arrival, there were 30 children (preschool school-age) and 5 staff (teachers) present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility. Hours of operation for the facility are Monday – Friday, 08:00AM-05:30PM. The facility has no active waivers or exceptions. All staff present had criminal record clearance. Facility Representative was 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. LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. Sign-in/out was observed to be completed with full legal signature and time of day. The last fire/disaster drill was conducted on 07/29/2024, which is compliant with the six month requirement for facilities. LPA observed a fully charged 3A40BC fire extinguisher last serviced 11/08/2023 and functioning smoke detector. A carbon monoxide detector was not observed. During the inspection, facility representative called the grounds keeper and had a brand new CO2 detector installed. Facility Representative states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Facility Representative states that there are no weapons or firearms on the premises. Continued on Page 2

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

Document Has Been Signed on 11/01/2024 01:49 PM - It Cannot Be Edited

Created By: Jennifer Beehler On 11/01/2024 at 12:11 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ONE WORLD MONTESSORI SCHOOL, INC. LEIGH	FACILITY NUMBER: 434415095
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation, the licensee did not comply with the section cited above 1 out of 1 times which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2024
	Plan of Correction
1 2 3 4	Licensee installed a CO2 detector during today's inspection. Citation cleared.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Joel Segura

LICENSING EVALUATOR NAME:

Jennifer Beehler

LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ONE WORLD MONTESSORI SCHOOL, INC. LEIGH	FACILITY NUMBER: 434415095
	VISIT DATE: 11/01/2024

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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-

Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. LPA observed sufficient age-appropriate materials, toys, craft station, books, learning materials and play equipment in the facility. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. There were one fish tank, one snake tank, and an empty amphibian tank in the classroom. Staff stated children assist in feeding and caring for the fish, but never assist in deep cleaning which is done when children are not in care. Drinking water is readily available for children in the facility via water dispensers and children bring re-usable bottles from home that have their names labeled. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom, not utilized by the children. There is a working telephone in the facility. Cleaning and maintenance for the facility is conducted by an outside service and is completed in the evenings after all day care children have left the premises, Monday - Friday.

The outdoor area of the facility was inspected and observed to be fenced in. LPA observed play equipment was in good condition, mostly age-appropriate, and has sufficient resilient materials such as tanbark and rubber mats below the exit shoot of slides. There was not a placard describing the age range for the play structure. Some parts of the structure did not appear age appropriate for ages 2-5 years old. Staff stated the children that cannot reach those portions do not play on the hanging parts of the structure. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by a large tree and a pergola where the sand boxes are kept. There was an additional fenced in area that was locked from the children in care. There was a garden, a chicken coop with chickens and a section for rabbits. Staff stated the children are admitted into this area under supervision in order to feed the animals and collect eggs. This is part of the Montessori curriculum to teach about plants, animals and the circle of life. Staff stated that deep cleaning of these areas is reserved for staff and ground maintenance when children are not in care as they require tools not suitable for the children.
Continued on Page 3

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ONE WORLD MONTESSORI SCHOOL, INC. LEIGH	FACILITY NUMBER: 434415095
	VISIT DATE: 11/01/2024

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
26
27
28
29
30
31
32

The facility provides an AM/PM snack daily. On Mondays a hot lunch of pasta is prepared in the kitchen by staff and offered to the children. Fridays a hot lunch of pizza is ordered and provided to the children. Children bring lunches Tuesday-Thursday or as a substitute if parents do not want them to participate in the hot lunch. LPA observed the kitchen to be clean and orderly. Stored food was not expired. Refrigerator was clean and special items for children like soy milk was clearly labeled with the child's name. Stored containers for child's lunch was observed to be labeled and properly stored. The Menu for snacks was posted at the entrance, but the hot lunch meals were not included. Equipment necessary for the storage, preparation and service of food is well maintained, clean, and sanitized after each use. The kitchen was off limits to the children through closed doors and locked gates, as cleaning products were stored under the sink.

5 (five) preschool aged children’s files were reviewed during today’s inspection for the following records: Physician’s Report (LIC701), Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Acknowledgment of Receipt of Licensing Report (LIC9224) - Report dated 01/31/2024, Signed Admission Agreement, and Immunization Records (PM286). LPA observed 1 out of 5 files where a TB assessment or proof of vaccination was missing. All other files were complete.

3 (three) staff files (1-Director, 2- Fully Qualified Teachers) were reviewed for the following records: Transcripts/Verification of Experience, Health Screening Report (LIC503), Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, Tuberculosis (TB) Clearance, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). There is at least one staff member present with current CPR/First-Aid that expires 08/2025. The staff files have current Mandated Reporter Training that expires on 09/06/2026. 1 out of 3 staff members has taken the wrong Mandated Reporter Class. LPA reminded Facility Representative that the Mandated Reporter Training must be renewed by all staff every 2 years and needs to meet the requirements of AB1207.

The Facility representative understands that the site director shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded Facility Representative 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, such as field trips.

Continued on Page 4

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ONE WORLD MONTESSORI SCHOOL, INC. LEIGH	FACILITY NUMBER: 434415095
	VISIT DATE: 11/01/2024

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
26
27
28
29
30
31
32

Facility Representative explained Director was out due to family obligations. LPA reminded Facility Representative that if the Director was out 30 days or more, another Director should be identified and reported to licensing in her absence. LPA did observe a Site Supervisor Permit for one of the Fully Qualified Teachers that were in attendance during inspection.

On 11/01/2024, LPA verified that the lead testing was completed on 12/22/2022 in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred Facility Representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

LPA reminded Facility Representative that testing will be required within 5 years of the last test. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

As a result of today's inspection a Type B citation was issued, details are included in the attached LIC9099-D.

Exit interview conducted and report was reviewed with Facility Representative, Kristi Burdsall and Assistant Director, Indu Nair. A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

Page: 5 of 5