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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415723
Report Date: 08/19/2022
Date Signed: 08/19/2022 11:51:51 AM


Document Has Been Signed on 08/19/2022 11:51 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:REACH MONTESSORI PRESCHOOLFACILITY NUMBER:
434415723
ADMINISTRATOR:JIAN DENGFACILITY TYPE:
850
ADDRESS:2490 STORY ROADTELEPHONE:
(408) 272-8888
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:60CENSUS: 17DATE:
08/19/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jian DengTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Oscar Huang conducted an unannounced case management - deficiencies inspection to the facility. LPA met with Director, Jian(Annie) Deng and explained to her the nature of today's inspection. LPA learned that the facility was using its preschool classroom for a non-CCL programan as well as an incident in which that there was a verbal argument between staff in front of day care children.

Deficiency was issued during the inspection. Deficiency, Plan of Correction (POC), and Appeal Rights were discussed with Director, Jian(Annie) Deng. Appeal Rights were provided to her. Exit interview conducted with Director, Jian(Annie) Dneg.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
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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Document Has Been Signed on 08/19/2022 11:51 AM - It Cannot Be Edited

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: REACH MONTESSORI PRESCHOOL
FACILITY NUMBER: 434415723

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2022
Section Cited

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Limitations on Capacity and Ambulatory Status: The licensee shall not exceed the conditions, limitations and capacity specified in the license.
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This requirement is not met as evidenced by: the facility was using its preschool classroom for a non-CCL program that the facility did not comply with the section cited above which posed an potential health, safety or personal rights risk to persons in care.
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Type B
08/31/2022
Section Cited

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Personal Rights: Each child shall be accorded dignity in his/her personal relationships with staff, and other persons.
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This requirement is not met as evidenced by: The Facility had an incident in which in between staff had a verbal argument in front of day care children.
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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: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2022
LIC809 (FAS) - (06/04)
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