434416981-8-17-2021-07-CC-SKNT-C63RX9-20210820132423

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434416981
Report Date: 08/17/2021
Date Signed: 08/17/2021 04:56:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2021 and conducted by Evaluator Anna Morales

COMPLAINT CONTROL NUMBER: 07-CC-20210813171542

FACILITY NAME:	PIEDMONT HILLS MONTESSORI ACADEMY		FACILITY NUMBER:	434416981
ADMINISTRATOR:	MICHELLE CONLON		FACILITY TYPE:	850
ADDRESS:	1425 OLD PIEDMONT ROAD		TELEPHONE:	(408) 923-5151
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	65	CENSUS: 12	DATE:	08/17/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Joanne Wu, Head of the School/Susanna Mora, Director		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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1. Preschool did not report the COVID positive case to Licensing in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Anna Morales conducted an Initial Visit for the above allegation. LPA was greeted by Joanne Wu, Head of School and Director Susanna Mora

Joanne Wu and Director stated that they obtained information stating that one of the students had tested positive on 8/12/2021. Joanne Wu stated that she assumed that an outbreak was multiple cases therefore she did not report to CCL as there was only one case of POSITIVE COVID-19.
Based on the information received Preschool did not report the COVID positive case to Licensing in a timely manner therefore the allegation of is SUBSTANTIATED.

The following Type b deficiency was cited on the attached page (9099-D). Appeal rights were provided to the Director prior to the conclusion of today's inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

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

LIC9099 (FAS) - (06/04)

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Control Number 07-CC-20210813171542

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 08/23/2021 Section Cited CCR 101212(d)(1)(E)	1 2 3 4 5 6 7	Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.	1 2 3 4 5 6 7	Joanne Wu agreed to review regulation, and submit a written plan stating the Protocols/ Procedure of an event of a student or staff are diagnosed with positive COVID-19 and submit a Unusual Incident by the POC date.
	8 9 10 11 12 13 14	in addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Epidemic outbreaks. Joanne Wu stated she did not notify Licensing Department of a Postive COVID-19 case, This poses a 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
	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: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

LIC9099 (FAS) - (06/04)

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