434415853-7-13-2021-07-CC-JGSS-C4VW26-20210713165349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415853
Report Date: 07/13/2021
Date Signed: 07/13/2021 04:53:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	ALOHA MONTESSORI		FACILITY NUMBER:	434415853
ADMINISTRATOR:	MARGARET EYERMAN		FACILITY TYPE:	850
ADDRESS:	995 APRICOT AVENUE		TELEPHONE:	(408) 858-9886
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	28	CENSUS: 6	DATE:	07/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Chasity Ramirez		TIME COMPLETED:	05:10 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	#2 Licensing Program Analyst (LPA) James Santos conducted an unannounced Annual inspection at the facility today. LPA met with Chasity Ramirez (Teacher). Administrator, Margaret Eyerman was not present in the facility during today's inspection. LPA spoke to her on the telephone and discussed with her the purpose of the visit. LPA toured the facility indoor and outdoor with Ms. Chasity. The school is currently operating a summer camp. The summer camp hours are from Monday through Friday from 8am - 3:30pm. Upon LPA's arrival, children were observed to be engaged in activities under the supervision of the teacher and a volunteer teacher aid. The activity and learning area was observed to be in good order. Furniture and equipment were observed to be age appropriate and in good condition. Disinfectants, cleaning solutions and other chemical items and sharp objects are stored and inaccessible to children. Children's restroom is clean and in good operating condition. Activities schedule and Menu are posted. Facility provides mid-day snacks. The children pack their own lunches from home and are properly stored in their backpacks in their cubbies with ice packs. Perishable food can also be stored in the refrigerator upon request. First aid kit, fire extinguisher, smoke and carbon monoxide detector were observed in the facility. The outdoor playground area is surrounded and enclosed by a fence. The outside area is observed to be free of hazards. The playground equipment were observed to be in good condition. Areas around high climbing equipment have resilient material to absorb falls. Drinking water were readily available to children indoor and outdoor. There were no bodies of water observed. Continued on next page

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ALOHA MONTESSORI	FACILITY NUMBER: 434415853
	VISIT DATE: 07/13/2021

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

LPA reviewed sign in and out record. Children's records were reviewed which include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment and Immunization.

Administrator's records were reviewed which included Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Immunization (Measles, Pertussis, and Flu) record and required Training. Chasity Ramirez's personnel record were not available in the facility for review during today's inspection. Chasity has fingerprint clearance but it's not associated with the facility. LPA reminded Administrator of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person. Licensees are encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs reviewed and provided licensee copies of the Lead Poisoning Facts Information and Safe Sleep Regulations (PIN 20-24-CCP).

LPA reminded Administrator that the online AB1207 Mandated Reported Training needs to be renewed every two years. Administrator stated that they aer not planning to provide (Incidental Medical Service) IMS at this time.

As a result of today's inspection, deficiencies were cited. See LIC809D page for deficiencies.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ALOHA MONTESSORI	FACILITY NUMBER: 434415853
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/14/2021 Section Cited	1 2 3 4 5 6 7	Criminal Record Clearance - (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 101170(f)
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Chasity Ramirez's fingerprint clearance has not been associated to the facility. This poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	Civil penalty of $100 was assessed.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ALOHA MONTESSORI	FACILITY NUMBER: 434415853
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/23/2021 Section Cited	1 2 3 4 5 6 7	Personnel Records - (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Chasity Ramirez's personnel record were not available in the facility for review during today's inspection. This poses an potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4