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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416981
Report Date: 06/04/2021
Date Signed: 06/14/2021 03:15:59 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:PIEDMONT HILLS MONTESSORI ACADEMYFACILITY NUMBER:
434416981
ADMINISTRATOR:MICHELLE CONLONFACILITY TYPE:
850
ADDRESS:1425 OLD PIEDMONT ROADTELEPHONE:
4089235151
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY:65CENSUS: 16DATE:
06/04/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Michelle Conlon, Juan Wu, & Joanne Margaret Robinson TIME COMPLETED:
03:45 PM
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LPA Stephanie Collins conducted an announced Pre-licensing Inspection and met with applicant Juan Wu--owner of Happiness Educare LLC. Also in attendance was Juan Wu's husband Mike Zhu, along with previous owner/administrator Margaret Robinson and director Michelle Conlon, to continue processing the Change of Ownership Application. Previous Licensee Margaret Robinson has provided written notice of her intentions to Community Care Licensing Office (CCL) and to the parents within the required 30-day time period. The applicant/owner is applying for a License to operate Piedmont Hills Montessori Academy Preschool at 1425 Old Piedmont Road. San Jose CA. 95132 with a capacity of 65 preschool children. The Academy will operate Monday through Friday from 07:00 AM to 06:00 PM, serving children 2-6 years old. Facility's phone number is (408) 923-5151. Fire clearance was received in CCL Office on 6/3/2021.

Indoor space for the Preschool was measured to ensure that there is 35 square feet of indoor activity space per child based on the total licensed capacity.

The indoor measurements are as follows:
Preschool/ Classroom areas I & IV
= (Total sq. ft.) – (Total Encumbered Space)
= (824.76.) – (0)
= 824.76 sq. ft.
Preschool/ Classrooms areas II & III
= (Total sq. ft.) – (Total Encumbered Space)
=(1,484.77 sq. ft) – (28.33 sq. ft.)
=1,456.44 sq. ft

Total Preschool Indoor Activity Space = (2,281.2 sq. ft.) divided by (35 sq. ft. / child)
= 65 Preschool children
There are 5 sinks and 7 toilets designated for preschool children to use.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
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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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: PIEDMONT HILLS MONTESSORI ACADEMY
FACILITY NUMBER: 434416981
VISIT DATE: 06/04/2021
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Outdoor space was measured to ensure that there is at least 75 square feet of outdoor activity space per child based on the total licensed capacity.

Playground 1 :
= (Total sq. ft.) – (Total Encumbered Space) = (5,833.179 sq. ft.) – (0 sq. ft.)
= 5833.179 sq. ft.
Playground 2
= (Total sq. ft.) – (Total Encumbered Space) = (4,343.556 sq. ft.) – (0 sq. ft.)
=4343.556 sq. ft.
Total Outdoor Activity Space = (10,176.735 sq. ft.) divided by (75 sq. ft. / child)
= 135 Children

LPA observed age appropriate outdoor play equipment for the preschool program and there are resilient materials under climbing play structure. The outdoor play space is surrounded by fencing. Shade is provided by trees and overhang. The drinking water outdoors is available via water cooler. The center does not provide transportation. LPA did not observe any bodies of water during the visit. Per fire clearance side yard to be off-limits To children with exception for emergency evacuation only.

There are five (5/75) sinks and seven (7/105) toilets available to server children in care. There is one staff restroom near the director’s office that will also be used by children who becomes ill. Sick children will be isolated near the director's office and isolation equipment is available . Piedmont Hills Montessori Academy will provide A M and P M snacks. Parents and guardians are requested to supply lunch form home. Meals can be prepped, stored, and warmed-up in the on-site fully equipped kitchen. The kitchen is equipped with stove, oven, hot and cold running water, refrigerator, microwave and dishwasher and counter space. LPA observed trash cans with tight fitting covers for the disposal of solid waste. Drinking water indoors and out is available via water coolers and pitchers.
LPA observed functioning smoke and carbon monoxide detectors, and fire extinguishers at the facility. The facility staff will clean toys and equipment daily per with cleaning wipes and solutions that will be kept inaccessible to children. The facility will follow COVID-19 protocols, procedures and guidelines. COVID-19 Self-Assessment submitted and filed.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PIEDMONT HILLS MONTESSORI ACADEMY
FACILITY NUMBER: 434416981
VISIT DATE: 06/04/2021
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First aid and medication will be stored in cabinets in each classroom inaccessible to children. LPA observed toys, furniture, and equipment such as tables, chairs, mats, etc.

Medications will be stored in the Director's Office. Incidental Medical Services (IMS) policy: 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)/ (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

A review of staff records today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Applicant is reminded 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12- month period

The Applicant understands the capacity of the Preschool. The Applicant understands that children's personal rights should not be violated; including no corporal punishment, Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for Teachers ,Directors.

The Director meets the education qualification requirement and has completed 16 hours of training on preventive health practices, which included pediatric cardiopulmonary resuscitation and pediatric first aid, and one hour on Child Care Nutrition with Lead Poisoning . Director has proof of immunity against Measles and Pertussis, and Health Screening with Tuberculosis test result.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PIEDMONT HILLS MONTESSORI ACADEMY
FACILITY NUMBER: 434416981
VISIT DATE: 06/04/2021
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Applicant is reminded of Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training. Applicant is reminded that Licensing forms and Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov

LPA reviewed State Required Posting:
Facility License/Waivers, Personal Rights-(LIC613A), aily Schedule, Parent’s Rights Poster (PUB393), Menus- (Current), Car Seat Safety (PUB269),Emergency Disaster Plan-(LIC 610), Earthquake Preparedness Checklist (LIC9148) and Notice of Site visit.

Children’s Records:
Identification Emer.info-( LIC 700), Health History-(LIC 702), Physician’s Report-(LIC 701),Consent for Emergency Treatment:- (LIC 627), Immunization Records, Parents Right Notification –(LIC 995), Personal Rights-(LIC 613A), Admission Agreement, Needs and Services Plan for Infants.

Staff Records:
TB Clearance/Health Screening-(LIC 503), Notice of Employee Rights-(LIC 9052), Acknowledgment to Report Child Abuse- (9108),Pediatric 1st Aid and CPR, College Transcripts or Permit,
Proof Immunization (MMR, Pertussis, Influenza, TB), Personal Record- (LIC 501), and Proof of Mandated Reporter Training.

And other monitored documentation's: Sign-In/Sign-Out ‘sheet-Current, Facility Roster
(LIC 9040), Facility Personnel Report (LIC 500)
Fire Drill/Disaster Log, Daily Activity Schedule, and Admission policy.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: PIEDMONT HILLS MONTESSORI ACADEMY
FACILITY NUMBER: 434416981
VISIT DATE: 06/04/2021
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Website for resource information: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov

LPA conducted an exit interview with the applicant/owner and Director a Provisional License will be approved pending the following:

1) Management's final review and approval of 90 day Provisional Licensure terms and conditions .

Due to technical difficulties while at the facility this report has been delivered and reviewed by e-mail and verified by "return receipt

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2021
LIC809 (FAS) - (06/04)
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