435700742-9-7-2021-52-CC-MOTI-C6MSG6-20210907135126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700742
Report Date: 09/07/2021
Date Signed: 09/07/2021 01:51:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GOLDEN HARVEST MONTESSORI SCHOOL-CALAVERAS CAMPUS		FACILITY NUMBER:	435700742
ADMINISTRATOR:	ALI, KIMBERLY S.		FACILITY TYPE:	850
ADDRESS:	451 LOS COCHES ROAD		TELEPHONE:	(510) 468-0060
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	60	CENSUS: 7	DATE:	09/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Kimberly Ali		TIME COMPLETED:	02:10 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	An announced pre-licensing inspection was conducted today 9/7/2021 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Applicant, Kimberly Ali. The applicant has submitted an application for a CHANGE in OWNERSHIP PRESCHOOL license for 60 preschool aged children. The program will operate from 7:00AM - 6:30PM, Monday through Friday, in 5 classrooms. Present during today's visit were 2 staff members and 7 preschool aged children. A health and safety inspection was conducted inside and outside and the measurements for preschool component are as follows: INDOORS: 2133.57 square feet = 61 children OUTDOORS: 2561.33 square feet = 34 children The center has obtained an approved fire inspection clearance from the Milpitas Fire Department on 8/5/2021 for a capacity of 60 preschool aged children. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 6 toilets and 7 sinks available for children. Staff toilet is located in the lobby. The facility has a kitchen and no cleaners or toxic materials were observed stored with food. Children will bring lunch and snack from home. Facility will have back up snacks should a child forget. The Director's office and staff bathroom will serve as isolation areas for sick children. This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GOLDEN HARVEST MONTESSORI SCHOOL-CALAVERAS CAMPUS	FACILITY NUMBER: 435700742
	VISIT DATE: 09/07/2021

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

The play yards are fenced in all around. Building overhang and tarp provide sufficient shade in the play yards. Children bring water bottles from home and are refilled by the facility as needed for indoor and outdoor activities. There is a microwave and refrigerator available. First aid supplies are available in the center. There is a working telephone on site. Carbon monoxide detector is available and operable. Electronic sign in/out will be utilized and each authorized representative will have a unique identifier and records the time of day.

Kimberly Ali is a fully qualified preschool director and has completed 16 hours of health and safety training including pediatric CPR and First Aid.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Facility Representative is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair.

A license for 60 preschool aged children operating out of 5 classrooms (Rooms 1 through 5) will be issued on today's date, 9/7/2021. A play yard waiver will be requested by facility representative.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2